Association Between Blood Pressure Variability and Short-Term Outcome After Intra-arterial Thrombectomy in Acute Stroke Patients With Large-Vessel Occlusion.

Mengqi Yang,Tao Lu,Yi He,Baohui Weng,Hong Yang

doi:10.3389/fneur.2020.604437

Mengqi Yang, Tao Lu + Show 3 more

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https://doi.org/10.3389/fneur.2020.604437

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Abstract

The optimal range of blood pressure variability (BPV) for acute stroke patients with large-vessel occlusion (LVO) remains unclear. This study investigated the association between BPV from admission through the first 24 h after intra-arterial thrombectomy (IAT) and short-term outcome in LVO patients. We retrospectively analyzed 257 consecutive patients with LVO stroke who were treated with IAT. BP values were recorded at 2-h intervals from admission through the first 24 h after IAT. BPV, as reflected by pulse pressure variability (PPV), was determined based on standard deviation (SD), coefficient of variation (CV), successive variation (SV), and the difference between maximum and minimum blood pressure (ΔBP; systolic BP minus diastolic BP). The association between BPV and clinical outcome (Modified Rankin Scale score at 90 days) was analyzed by multivariate logistic regression analysis. Of the 257 included patients, 70 had a good outcome at 3 months. PPV from admission through the first 24 h after IAT was independently associated in a graded manner with poor outcome [multivariable-adjusted odds ratios (95% confidence interval) for the highest of PPV were 43.0 (8.7–212.8) for SD, 40.3 (9.8–165.0) for CV, 55.0 (11.2–271.2) for SV, and 40.1 (8.0–201.9) for ΔBP]. The area under the receiver operating characteristic curve (95% confidence interval) of the PPV parameters were 0.924 (0.882–0.965) for SD, 0.886 (0.835–0.938) for CV, 0.932 (0.891–0.973) for SV, and 0.892 (0.845–0.939) for ΔBP, and the Youden index values were 0.740, 0.633, 0.759, and 0.756, respectively. In summary, BPV from admission through the first 24 h after IAT was independently associated with poor outcome at 3 months in patients with LVO, with greater variability corresponding to a stronger association. Thus, PPV may be a clinically useful predictor of functional prognosis in LVO patients treated with IAT.

Highlights

Endovascular treatment (EVT) is a treatment option for acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) [1, 2]
Patients who met the following criteria were enrolled: [1] age ≥18 years; [2] AIS identified by head computed tomography (CT) or magnetic resonance imaging (MRI) at admission and LVO diagnosed by digital subtraction angiography (DSA); [3] patients underwent intra-arterial thrombectomy (IAT) within 24 h after symptom onset; [4] prestroke Modified Rankin Scale score
The clinical outcome of LVO patients treated with endovascular treatment (EVT) is affected by many factors including age, hypertension, and stroke severity, among others [5, 19]

Summary

Introduction

Endovascular treatment (EVT) is a treatment option for acute ischemic stroke (AIS) patients with large-vessel occlusion (LVO) [1, 2]. There is no standard approach for BP management in the acute phase of ischemic stroke [8, 9], and the relationship between BPV and the clinical outcome of AIS patients who have undergone EVT is unclear. Previous studies have calculated the BPV of SBP and diastolic (D)BP separately, and there have been few reports on the degree of PPV in the acute phase of AIS patients who have undergone intra-arterial thrombectomy (IAT) and its relationship with clinical outcome.

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