Abstract WP24: Impact of Blood Pressure Control in First 24 Hrs Post-Thrombectomy

Abstract

Introduction: The importance of blood pressure control after IV tPA is well known. Current practice is to use these same parameters for patients undergoing Endovascular Thrombectomy (ET). However, optimal blood pressure control following ET is not well defined, the DAWN trial used a target of <140mmHg in their study population and there is retrospective evidence that a target of <160mmHg is associated with good outcomes. Herein, we provide retrospective evidence in regards to likelihood of good outcomes based on relative SBP control after successful ET. Methods: A retrospective analysis of patients who underwent ET was conducted from January 2017 to April 2018 yielding 92 patients; those with unsuccessful recanalization or incomplete data were excluded leaving 51 for final analysis. Patients were dichotomized in two groups based on good (mRS ≤ 2) and bad (mRS ≥3) outcomes. We performed an ROC analysis to determine the percentage of time that SBP exceeded 140mmHg in order to be associated with a poor outcome at 90 days. Results: ROC analysis found that when 45% of SBP readings exceeded 140mmHg, there was a poor outcome at 90 days with sensitivity and specificity of 61 and 82%, respectively. The AUC of this analysis was 0.71 with a p-value of <0.05. The PPV and NPV for this cutoff were 80% and 66%, respectively. Conclusion: The percentage of time that SBP exceeds the target of 140mmHg in the first 24 hours appears to have an independent correlation with outcome in patients after successful ET. Those patients with uncontrolled SBP, defined as SBP >140mmHg 45% of the time or more experienced a poor outcome in 80% of cases. Those patients with controlled SBP, defined as <140mmHg 55% of the time or more experienced a good outcome in 82% of cases. Our study has obvious limitations due to the retrospective nature of the study and small sample size. While the values we studied for SBP control do not represent the continuously variable nature of this parameter, they do represent a general trend and are compatible with the standard of care seen amongst facilities providing ET. A randomized controlled trial to study these findings could have great implications to current practice.