Associations of various blood pressure parameters with functional outcomes after endovascular thrombectomy in acute ischaemic stroke.

Abstract

High blood pressure (BP) at presentation is associated with poor outcomes in acute ischaemic stroke, but serial BP measurements may better delineate the clinical implications of BP. The aim was to investigate the association between various BP parameters and functional outcomes in acute ischaemic stroke patients treated with endovascular thrombectomy (EVT). This study reports a retrospective analysis of a prospective registry of a comprehensive stroke centre. Patients treated with EVT due to large vessel occlusion in the anterior circulation were enrolled. BP was measured hourly during the first 24h after admission. Associations of various BP parameters, including BP variability, with functional outcomes at 3months, including good outcomes (modified Rankin Scale score of 0-2), were analysed. Of the 378 enrolled patients (mean age 70±11years, male 54.2%), 313 (82.8%) achieved successful reperfusion after EVT, and 149 (39.4%) had good outcomes at 3months. Higher mean systolic BP [each 10mmHg increase, odds ratio 0.82 (0.69-0.97)] and higher systolic successive variation (SV) [each 10% increase, odds ratio 0.37 (0.18-0.76)] were associated with a reduced likelihood of achieving good outcomes. In addition, reperfusion status after EVT moderated the influence of higher systolic SV on good outcomes (Pint =0.05). The results showed that a higher mean systolic BP and systolic SV during the first 24h of EVT reduced the likelihood of good outcomes at 3months. The effects of these parameters on outcomes are more substantial amongst patients with successful reperfusion after EVT, suggesting that different BP control strategies should be employed according to reperfusion status.