Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients.

MedStar author(s):
Citation: Journal of Neurointerventional Surgery. 10(10):925-931, 2018 Oct.PMID: 29326379Institution: MedStar Washington Hospital CenterDepartment: Critical CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Blood Pressure/ph [Physiology] | *Cerebrovascular Disorders/di [Diagnosis] | *Hypertension/di [Diagnosis] | *Thrombectomy/td [Trends] | Adult | Aged | Cerebrovascular Disorders/pp [Physiopathology] | Cerebrovascular Disorders/su [Surgery] | Cohort Studies | Female | Humans | Hypertension/et [Etiology] | Hypertension/pp [Physiopathology] | Male | Middle Aged | Prospective Studies | Retrospective Studies | Thrombectomy/ae [Adverse Effects] | Treatment OutcomeYear: 2018Local holdings: Available online through MWHC library: 2009 - presentISSN:
  • 1759-8478
Name of journal: Journal of neurointerventional surgeryAbstract: CONCLUSIONS: Our study demonstrates that wide BP excursions from the mean during the first 24hours post MT are associated with worse outcomes in patients with nrLVO.Copyright (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.METHODS: Hourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24hours following MT in consecutive nrLVO patients. Maximum, minimum, and mean BP levels were documented. Three-month functional independence (FI) was defined as modified Rankin Scale (mRS) scores of 0-2.OBJECTIVE: Permissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO.RESULTS: A total of 88 nrLVO patients were evaluated post MT. Patients with FI had lower maximum SBP (160+/-19mmHg vs 179+/-23mmHg; P=0.001) and higher minimum SBP levels (119+/-12mmHg vs 108+/-25mmHg; P=0.008). Maximum SBP (183+/-20mmHg vs 169+/-23mmHg; P=0.008) and DBP levels (105+/-20mmHg vs 89+/-18mmHg; P=0.001) were higher in patients who died at 3 months while minimum SBP values were lower (102+/-28mmHg vs 115+/-16mmHg; P=0.007). On multivariable analyses, both maximum SBP (OR per 10mmHg increase: 0.55, 95%CI 0.39 to 0.79; P=0.001) and minimum SBP (OR per 10mmHg increase: 1.64, 95%CI 1.04 to 2.60; P=0.033) levels were independently associated with the odds of FI. Maximum DBP (OR per 10mmHg increase: 1.61; 95%CI 1.10 to 2.36; P=0.014) and minimum SBP (OR per 10mmHg increase: 0.65, 95%CI 0.47 to 0.90; P=0.009) values were independent predictors of 3-month mortality.All authors: Alexandrov AV, Alsbrook D, Alsherbini K, Arthur AS, Chang JJ, Dillard K, Elijovich L, Goyal N, Hoit D, Krishnaiah B, Nickele C, Pandhi A, Tsivgoulis GFiscal year: FY2019Fiscal year of original publication: FY2018Digital Object Identifier: Date added to catalog: 2018-01-22
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29326379 Available 29326379

Available online through MWHC library: 2009 - present

CONCLUSIONS: Our study demonstrates that wide BP excursions from the mean during the first 24hours post MT are associated with worse outcomes in patients with nrLVO.

Copyright (c) Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

METHODS: Hourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24hours following MT in consecutive nrLVO patients. Maximum, minimum, and mean BP levels were documented. Three-month functional independence (FI) was defined as modified Rankin Scale (mRS) scores of 0-2.

OBJECTIVE: Permissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO.

RESULTS: A total of 88 nrLVO patients were evaluated post MT. Patients with FI had lower maximum SBP (160+/-19mmHg vs 179+/-23mmHg; P=0.001) and higher minimum SBP levels (119+/-12mmHg vs 108+/-25mmHg; P=0.008). Maximum SBP (183+/-20mmHg vs 169+/-23mmHg; P=0.008) and DBP levels (105+/-20mmHg vs 89+/-18mmHg; P=0.001) were higher in patients who died at 3 months while minimum SBP values were lower (102+/-28mmHg vs 115+/-16mmHg; P=0.007). On multivariable analyses, both maximum SBP (OR per 10mmHg increase: 0.55, 95%CI 0.39 to 0.79; P=0.001) and minimum SBP (OR per 10mmHg increase: 1.64, 95%CI 1.04 to 2.60; P=0.033) levels were independently associated with the odds of FI. Maximum DBP (OR per 10mmHg increase: 1.61; 95%CI 1.10 to 2.36; P=0.014) and minimum SBP (OR per 10mmHg increase: 0.65, 95%CI 0.47 to 0.90; P=0.009) values were independent predictors of 3-month mortality.

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