Abstract W P2: Timeline of Blood Pressure Changes After Intra-arterial Therapy For Acute Ischemic Stroke Based on Recanalization Status

Abstract

Introduction: Arterial recanalization with intravenous thrombolysis early for acute ischemic stroke (AIS) has been reported to be associated with spontaneous blood pressure (BP) reduction compared to those without recanalization. We investigated the course of BP after intra-arterial therapy (IAT) for AIS. Methods: Retrospective study from 1/08-12/12 of AIS patients who underwent IAT for ICA/M1 occlusions with TICI 0 flow was conducted. Cases under general anesthesia were excluded. BP recorded before, and at hourly intervals for 36 hours post procedure was collected. The average hourly BP, and the difference in hourly BP from pre-procedure baseline was calculated and compared by recanalization status. Successful recanalization was defined as TICI2b-3. Results: Sixty-two patients consisting of 37 (59.7%) with TICI2b-3 (Group R) and 25 with TICI 0-2a (Group NR) recanlization were included. Baseline characteristics were similar except for greater frequency of IV tPA administration in group R (51.3% vs. 20.8%, p 0.017). Average systolic BP (SBP) pre-procedure was similar in both both groups (R 158 vs NR 154 mm Hg, p 0.521). SBP decreased significantly at the end of procedure in both groups (Fig a,b), but without inter-group difference (Fig c). With time however, there was significantly lower average SBP, and greater SBP drop from baseline in the R group compared to NR group, but this persisted only till hour 12. (Fig 1c,d) Similar trend was observed with the mean arterial BP. Conclusions: BP after IAT differed significantly based on recanalization status and the difference was early. Endogenous drive to increase BP to maintain cerebral perfusion may account for the findings. This may have implications for BP management post IAT.