Abstract WP154: Presentation Blood Pressure Is Associated With Infarct Growth In Large Vessel Occlusion Acute Ischemic Stroke

Abstract

Introduction: The optimal blood pressure (BP) in patients with large vessel occlusion (LVO) acute ischemic stroke (AIS). Here, we explore the relationship between CT perfusion (CTP) predicted infarct volumes and those seen on follow up MRI, to examine whether infarct growth is related to presentation BP. Methods: From our prospectively collected multi-institutional registry, we identified patients with LVO AIS seen at 4 comprehensive stroke centers from January 2018 to March 2021. Patients were included if they contained anterior circulation LVO (defined as occlusion of the intracranial ICA, MCA or ACA) defined by CTA, included if they underwent CTP with RAPID (IschemiaView) post-processing at the time of presentation, and had final infarct volume (FIV) imaging with MRI 48-72 hours later. Infarct growth was defined as increase in infarct volume of at least 10 mL from CTP-RAPID core volume prediction to FIV. The primary outcome was the effect of presentation mean arterial blood pressure (MAP) on likelihood of infarct growth. Results: Among 329 patients that met inclusion criteria, median age was 68 [IQR 58-70], median NIHSS was 15 [IQR 10-20] and 49% were female. Median ASPECTS was 8 [6-9], median CTP-RAPID core was 6 mL [0-36 mL] and median FIV was 19 mL [5-57 mL]. Median arrival systolic BP was 153 mmHg [132-174 mmHg], diastolic was 83 mmHg [73-92 mmHg] and MAP was 105 mmHg [95- 118]. 161 (49%) of patients presented in the early time window. Infarct growth of at least 10 mL was seen in 23 (7%) of patients. FIV correlated with CTP-RAPID core more clearly for patients in the early vs. late window (R=0.77 vs 0.34, early vs. late window). In the subset of patients presenting in the early time window, those who underwent infarct growth of at least 10 mL were more likely to present with greater MAPs (mean MAP 118 vs. 106, infarct growth vs. no growth, p<0.05). This relationship was not seen in patients in the late window. Conclusions: Infarct expansion from presentation to FIV was seen in a substantial proportion of patients and associated with greater MAPs in the early but not late window. There are multiple possible explanations for this finding, including increased CTP inaccuracies in the early time window, and potentially with elevated BP. Further work on the optimal BP in LVO AIS is needed.