Abstract
Introduction: Several factors influence the outcome of patients who undergo intra-arterial therapy (IAT) for acute ischemic stroke (AIS). The influence of intra-procedural hemodynamics on functional outcome and mortality has not been studied. There is no data to guide intraprocedural blood pressure (BP) management and it is unknown whether systolic, diastolic, or mean arterial pressure (MAP) is important for determining outcomes. Methods: Retrospective study of patents that underwent IAT for anterior circulation AIS between 1/08- 12/12 was conducted. Detailed intra-procedural hemodynamics, demographics, NIH stroke scale score, IV tPA use, thrombus location, recanalization grade, intracranial hemorrhage were collected. Outcomes measured were in-hospital mortality and 30-day good outcome defined as modified Rankin Scale score of 0-2. Successful recanalization was defined as TICI 2b-3 and ICH was classified into parenchymal hematoma (PH1+2) and hemorrhagic infarction (HI 1+ 2). Results: The cohort in the analysis consisted of 190 patients (56% females, mean age 67 + 15 years). Thirty-six (19%) patients died in-hospital, and 25 (17%) achieved an mRS 0-2. Intra-procedural maximum systolic BP (SBP) and maximum MAP were significantly lower in the good outcome group (Table 1). In multivariable logistic regression analysis, maximum MAP was an independent predictor of good outcomes along with baseline CT ASPECTS score, and successful recanalization. Maximum MAP was also an independent predictor of mortality along with age and presence of PH 1+2 ICH. Conclusions: Maximum intraprocedural MAP was an independent predictor of good outcome and mortality in in patients undergoing IAT for AIS. This results may have implications for intraprocedural BP management.
Published Version
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