Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Neurology
Published in: BMC Neurology 1/2023

Open Access 01-12-2023 | Stroke | Research

Prognostic significance of blood pressure parameters after mechanical thrombectomy according to collateral status

Authors: Huaishun Wang, Huihui Liu, Qianmei Jiang, Shoujiang You, Zhiliang Guo, Jie Hou, Guodong Xiao

Published in: BMC Neurology | Issue 1/2023

Login to get access

Abstract

Background

Mechanical thrombectomy (MT) has been proven as an effective and safe therapy for patients with acute ischemic stroke from large vessel occlusion. However, there is still a controversial topic about post-procedural management including blood pressure (BP).

Methods

A total of 294 patients who received MT in Second Affiliated Hospital of Soochow University from April 2017 to September 2021 were included consecutively. The association of blood pressure parameters (BPV and hypotension time) with poor functional outcome was evaluated using logistic regression models. Meanwhile, the effects of BP parameters on mortality was analyzed using cox proportional hazards regression models. Furthermore, the corresponding multiplicative term was added to the above models to study the interaction between BP parameters and CS.

Results

Two hundred ninety four patients were included finally. The mean age was 65.5 years. At the 3-month follow-up, 187(61.5%) had poor functional outcome and 70(23.0%) died. Regardless of the CS, BP CV is positively associated with poor outcome. Hypotension time was negatively associated with poor outcome. We conducted a subgroup analysis according to CS. BPV was significantly associated with mortality at 3-month and displayed a trend toward poor outcome for patients with poor CS only. The interaction between SBP CV and CS with respect to mortality after adjusting for confounding factors was statistically significant (P for interaction = 0.025) and the interaction between MAP CV and CS with respect to mortality after multivariate adjustment was also statistically significant (P for interaction = 0.005).

Conclusion

In MT-treated stroke patients, higher BPV in the first 72 h is significantly associated with poor functional outcome and mortality at 3-month regardless of CS. This association was also found for hypotension time. Further analysis showed CS modified the association between BPV and clinical prognosis. BPV displayed a trend toward poor outcome for patients with poor CS.
Appendix
Available only for authorised users
Literature
1.
Smith W, Lev M, English J, et al. Significance of large vessel intracranial occlusion causing acute ischemic stroke and TIA. Stroke. 2009;40(12):3834–40.CrossRefPubMedPubMedCentral
2.
Berkhemer O, Fransen P, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med. 2015;372(1):11–20.CrossRefPubMed
3.
Jovin T, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med. 2015;372(24):2296–306.CrossRefPubMed
4.
Goyal M, Demchuk A, Menon B, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372(11):1019–30.CrossRefPubMed
5.
Campbell B, Mitchell P, Kleinig T, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med. 2015;372(11):1009–18.CrossRefPubMed
6.
Saver J, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med. 2015;372(24):2285–95.CrossRefPubMed
7.
de Havenon A, Majersik J, Stoddard G, et al. Increased Blood Pressure Variability Contributes to Worse Outcome After Intracerebral Hemorrhage. Stroke. 2018;49(8):1981–4.CrossRefPubMedPubMedCentral
8.
de Havenon A, Stoddard G, Saini M, et al. Increased blood pressure variability after acute ischemic stroke increases the risk of death: A secondary analysis of the Virtual International Stroke Trial Archive. JRSM Cardiovasc Dis. 2019;8:2048004019856496.PubMedPubMedCentral
9.
Rose J, Mayer S. Optimizing blood pressure in neurological emergencies. Neurocrit Care. 2004;1(3):287–99.CrossRefPubMed
10.
Bath P, Appleton J, Krishnan K, et al. Blood Pressure in Acute Stroke: To Treat or Not to Treat: That Is Still the Question. Stroke. 2018;49(7):1784–90.CrossRefPubMed
11.
Nogueira R, Jadhav A, Haussen D, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med. 2018;378(1):11–21.CrossRefPubMed
12.
13.
Samuels N, van de Graaf R, Dippel D. Letter by Samuels et al Regarding Article, “Decreases in Blood Pressure During Thrombectomy Are Associated With Larger Infarct Volumes and Worse Functional Outcome.” Stroke. 2019;50(11): e320.CrossRefPubMed
14.
15.
Campbell B, Majoie C, Albers G, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol. 2019;18(1):46–55.CrossRefPubMed
16.
Liebeskind D, Tomsick T, Foster L, et al. Collaterals at angiography and outcomes in the Interventional Management of Stroke (IMS) III trial. Stroke. 2014;45(3):759–64.CrossRefPubMedPubMedCentral
17.
Liu L, Ding J, Leng X, et al. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke Vasc Neurol. 2018;3(3):117–30.CrossRefPubMedPubMedCentral
18.
Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344–418.CrossRefPubMed
19.
Zaidat O, Yoo A, Khatri P, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement. Stroke. 2013;44(9):2650–63.CrossRefPubMedPubMedCentral
20.
21.
Emberson J, Lees K, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet (London, England). 2014;384(9958):1929–35.CrossRefPubMed
22.
Goyal M, Menon B, van Zwam W, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet (London, England). 2016;387(10029):1723–31.CrossRefPubMed
23.
Leslie-Mazwi T, Chen M, Yi J, et al. Post-thrombectomy management of the ELVO patient: Guidelines from the Society of NeuroInterventional Surgery. J Neurointerv Surg. 2017;9(12):1258–66.CrossRefPubMed
24.
Qureshi A, Ezzeddine M, Nasar A, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med. 2007;25(1):32–8.CrossRefPubMedPubMedCentral
25.
Qureshi A. Acute hypertensive response in patients with stroke: pathophysiology and management. Circulation. 2008;118(2):176–87.CrossRefPubMed
26.
Carcel C, Anderson C. Timing of blood pressure lowering in acute ischemic stroke. Curr Atheroscler Rep. 2015;17(8):42.CrossRefPubMed
27.
Sargento-Freitas J, Laranjinha I, Galego O, et al. Nocturnal blood pressure dipping in acute ischemic stroke. Acta Neurol Scand. 2015;132(5):323–8.CrossRefPubMed
28.
Müller M, Österreich M, Müller A, et al. Assessment of the Brain’s Macro- and Micro-Circulatory Blood Flow Responses to CO2 via Transfer Function Analysis. Front Physiol. 2016;7:162.CrossRefPubMedPubMedCentral
29.
Lang E, Lagopoulos J, Griffith J, et al. Cerebral vasomotor reactivity testing in head injury: the link between pressure and flow. J Neurol Neurosurg Psychiatry. 2003;74(8):1053–9.CrossRefPubMedPubMedCentral
30.
Bennett A, Wilder M, McNally J, et al. Increased blood pressure variability after endovascular thrombectomy for acute stroke is associated with worse clinical outcome. J Neurointerv Surg. 2018;10(9):823–7.CrossRefPubMed
31.
Mistry E, Mehta T, Mistry A, et al. Blood Pressure Variability and Neurologic Outcome After Endovascular Thrombectomy: A Secondary Analysis of the BEST Study. Stroke. 2020;51(2):511–8.CrossRefPubMed
32.
Man S, Aoki J, Hussain M, et al. Predictors of infarct growth after endovascular therapy for acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015;24(2):401–7.CrossRefPubMed
33.
Puhr-Westerheide D, Tiedt S, Rotkopf L, et al. Clinical and Imaging Parameters Associated With Hyperacute Infarction Growth in Large Vessel Occlusion Stroke. Stroke. 2019;50(10):2799–804.CrossRefPubMed
34.
Jung S, Gilgen M, Slotboom J, et al. Factors that determine penumbral tissue loss in acute ischaemic stroke. Brain J Neurol. 2013;136:3554–60.CrossRef
35.
Payabvash S, Taleb S, Qureshi A. Cerebral regions preserved by successful endovascular recanalization of acute M1 segment occlusions: a voxel based analysis. Br J Radiol. 2017;90(1072):20160869.CrossRefPubMedPubMedCentral
36.
Nambiar V, Sohn S, Almekhlafi M, et al. CTA collateral status and response to recanalization in patients with acute ischemic stroke. AJNR Am J Neuroradiol. 2014;35(5):884–90.CrossRefPubMedPubMedCentral
37.
Caplan L, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol. 1998;55(11):1475–82.CrossRefPubMed
Metadata
Title
Prognostic significance of blood pressure parameters after mechanical thrombectomy according to collateral status
Authors
Huaishun Wang
Huihui Liu
Qianmei Jiang
Shoujiang You
Zhiliang Guo
Jie Hou
Guodong Xiao
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2023
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/s12883-023-03160-3

Other articles of this Issue 1/2023

BMC Neurology 1/2023 Go to the issue

Research

Effects of functional performance and national health insurance cost on length of hospitalization for postacute care in stroke: a retrospective observational study

Research

Clinical characteristics of cerebral venous sinus thrombosis patients with new-onset of headache

Research

What predicts large vessel occlusion in mild stroke patients?

Research article

Computed tomography derived cervical fat-free muscle fraction as an imaging-based outcome marker in patients with acute ischemic stroke: a pilot study

Research article

Time course of neuroinflammation after human stroke – a pilot study using co-registered PET and MRI

Research

Neurophysiological visual assessment in patients with idiopathic intracranial hypertension: visual evoked potential and multifocal field electroretinography