Highlights
- •Elevation of blood pressure (BP) after mechanical thrombectomy (MT) can theoretically restore cerebral perfusion to the ischemic brain tissue, but it comes at a risk of causing reperfusion injury.
- •We aim to determine the association of 24-h post-MT BP parameters with clinical outcomes depending on the pre-MT collateral status.
- •Our study demonstrates that there is a significant difference with respect to certain 24-h post-MT blood pressure parameters in patients on clinical outcomes depending on their collateral status. In our study, some higher blood pressure parameters were associated with worse outcomes in patients with a poor collateral profile, however, this effect was not replicated in patients with a good collateral profile.
Abstract
Introduction
Elevation of blood pressure (BP) after mechanical thrombectomy (MT) can theoretically
restore perfusion to the ischemic brain tissue, but it comes at a risk of causing
reperfusion injury. We aim to determine the association of 24-h post-MT BP parameters
with clinical outcomes depending on the pre-MT collateral status.
Methods
We performed a retrospective chart review of patients who underwent MT at a comprehensive
stroke center from 7/2014 to 12/2020. The patients were divided into good versus poor
collateral groups depending on their collateral status. A board-certified neuroradiologist,
who was blinded to the clinical outcomes, used collateral grading score of Miteff
≥3 to designate good collaterals on the pre-MT CT Angiogram. A binary logistic regression
analysis was performed, controlling for baseline parameters, with the 24-h post-MT
BP parameters as predictors. The outcomes were functional dependence [3-month mRS
(3–6)] and mortality.
Results
A total of 220 met the inclusion criteria. In the multivariable analysis, for patients
with poor collaterals, the parameters of higher mean SBP (131.7 ± 12.7 vs. 122.3 ± 14.2;
OR, 1.06; 95% CI, 1.01–1.11; P 0.022), higher mean MAP (91.2 ± 8.2 vs. 86.1 ± 6.3;
OR, 1.13; 95% CI, 1.03–1.23; P 0.015) and a higher maximum SBP (156.3 ± 13.7 vs. 145.3 ± 19.1;
OR, 1.05; 95% CI, 1.01–1.1; P 0.019) were significantly associated with functional
dependence at 3-months. For patients with good collaterals, the parameters of lower
24-h mean DBP (69.1 ± 11.1 vs. 73.8 ± 11 95% CI, OR, 0.96; 95% CI, 0.92–1; P 0.025)
was significantly associated with higher mortality at 3-months. Conclusion: Our study demonstrates that there is a significant difference with respect to certain
24-h post-MT BP parameters in patients on clinical outcomes depending on their collateral
status. In our study, some higher BP parameters were associated with worse outcomes
in patients with a poor collateral profile, however, this effect was not replicated
in patients with a good collateral profile.
Keywords
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Article info
Publication history
Published online: August 01, 2022
Accepted:
July 27,
2022
Received in revised form:
July 7,
2022
Received:
February 13,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
