Abstract
BackgroundEndovascular treatment (EVT) is advocated for acute ischaemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging. This study investigated the relationship between post-EVT short-term blood pressure variability (BPV) and early outcomes in LVO patients.MethodsWe retrospectively reviewed 72 LVO patients undergoing EVT between June 2015 and June 2018. Hourly systolic and diastolic blood pressures (SBP and DBP, respectively) were recorded in the first 24 h post-EVT. BPV were evaluated as standard deviation (SD), coefficient of variation (CV), and successive variation (SV) separately for SBP and DBP. Functional independence at 3 months was defined as a modified Rankin Scale (mRS) score of 0–2.ResultsFor 58.3% patients with favorable outcomes, the median National Institutes of Health Stroke Scale and Alberta Stroke Program Early CT scores on admission were 14 and 8, respectively. The maximum SBP ([154.3 ± 16.8] vs. [163.5 ± 15.6], P = 0.02), systolic CV ([8. 8% ± 2.0%] vs. [11.0% ± 1.8], P < 0.001), SV ([11.4 ± 2.3] vs. [14.6 ± 2.0], P < 0.001), and SD ([10.5 ± 2.4] vs. [13.8 ± 3.9], P < 0.001) were lower in patients with favorable outcomes. On multivariable logistic regression analysis, systolic SV (OR: 4.273, 95% CI: 1.030 to 17.727, P = 0.045) independently predicted unfavorable prognosis. The area under the curve was 0.868 (95% CI: 0.781 to 0.955, P < 0.001), and sensitivity and specificity were 93.3% and 73.8%, respectively, showing excellent predictive value for 3-month poor-outcomes.ConclusionsDecreased systolic SV following intra-arterial therapies result in favorable outcomes at 3 months. Systolic SV may be a novel predictor of functional prognosis in LVO patients.
Highlights
Endovascular treatment (EVT) is advocated for acute ischaemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging
Systolic successive variation (SV) may be a novel predictor of functional prognosis in LVO patients
The inclusion criteria were as follows: (1) age of ≥18 years; (2) Acute ischaemic stroke (AIS) confirmed via head computed tomography (CT) or magnetic resonance imaging at admission; (3) occlusion of the internal carotid artery or M1 of the middle cerebral artery diagnosed within 6 h after onset by digital subtraction angiography; (4) preoperative Alberta Stroke Program Early CT Score (ASPECTS) of ≥6, prestroke modified Rankin Scale score of < 2, and National Institutes of Health Stroke Scale (NIHSS) score of ≥6; (5) treatment initiated within 6 h of symptom onset; (6) clinical features and blood pressure (BP) recorded at baseline and hourly for at least 24 h after EVT; and (7) follow up by phone or face-to-face consultations at 3 months with complete documentation
Summary
Endovascular treatment (EVT) is advocated for acute ischaemic stroke with large-vessel occlusion (LVO), but perioperative periods are challenging. This study investigated the relationship between post-EVT shortterm blood pressure variability (BPV) and early outcomes in LVO patients. Endovascular treatment (EVT) for patients who had acute ischaemic stroke with large-vessel occlusion (AIS-LVO) is highly recommended based on the findings of six randomized controlled clinical trials [1,2,3,4,5,6]. Several factors during the perioperative period of EVT, including blood pressure (BP) management, need urgent attention. Association and American Stroke Association guidelines for the early management of patients with AIS recommends maintaining the BP at < 180/105 mmHg (IIb, B-NR) in patients who underwent mechanical thrombectomy (MT) with successful reperfusion [7]. Reperfusion injury may occur dispite maintaining the BP within the target range
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