Abstract TP411: Distinct Systolic Blood Pressure Trajectories 72 Hours After Mechanical Thrombectomy Predict Hemorrhagic Transformation and Poor Functional Outcome

Introduction: Blood pressure (BP) is an important modifiable parameter after endovascular thrombectomy (EVT). Observational studies have found associations between elevated BP after EVT with hemorrhagic transformation and poor functional outcome. However, blood pressure course after EVT has not been well characterized and optimal hemodynamic management in the immediate post-stroke period remains unresolved. We utilized blood pressure data up to 72 hours after EVT to identify distinct systolic BP (SBP) trajectories and studied their associations with functional outcome. Methods: We retrospectively studied a multicenter cohort of 1060 patients with large-vessel occlusion stroke who underwent EVT. BP was recorded non-invasively recorded at least hourly for the first 72 hours. Functional outcome was assessed using the modified Rankin scale (mRS). Favorable functional outcome was defined as mRS &lt. Latent variable mixture modeling was applied to identify patient subgroups that have comparable SBP trajectories. All analyses were adjusted for age, admission NIHSS, and recanalization status. Results: One thousand sixty patients (mean age 70±15, mean NIHSS 16) were included in the analysis. Five distinct SBP trajectories were identified: (1) low (17%), (2) moderate (38%), (3) moderate-to-high (21%), (4) high-to-moderate (17%), and (5) high (7%) (Figure 1A). SBP trajectory group was an independent predictor of functional outcome at discharge (p=0.001) and 90 days (p=0.010, Figure 1B). Patients with high and high-to-moderate SBP trajectories had a significantly higher odds of an unfavorable outcome at 90 days (adjusted OR 2.3, 95%CI 1.2 - 4.3, p=0.01 and adjusted OR 4, 95% CI 1.5-10.7, p=0.06, respectively) Conclusions: During the first 72 hours after EVT, acute ischemic stroke patients show distinct SBP trajectories, which differ in relation to functional outcome. The findings may help recognize potential candidates for future blood pressure control trials.

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Abstract TMP88: Blood Pressure Variability Within 24 Hours After Recanalization Worsens Functional Outcome Among Patients Who Underwent Endovascular Treatment

Stroke ◽

10.1161/str.51.suppl_1.tmp88 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Daniel Campos ◽

Manuel Requena ◽

Mariana Carvalho ◽

Marlene Saraiva ◽

Alvaro Garcia-Tornel ◽

...

Keyword(s):

Blood Pressure ◽

Endovascular Treatment ◽

Functional Outcome ◽

Systemic Blood Pressure ◽

Hemorrhagic Transformation ◽

Poor Functional Outcome ◽

Ischemic Tissue ◽

Increased Risk ◽

Potential Risks

Introduction: Systemic blood pressure (BP) should be strictly monitored and adjusted during the initial stages of stroke. Due to the impairment of cerebral autoregulation, cerebral blood flow is directly affected by systemic BP and some degree of permissive hypertension might be beneficial prior to reperfusion treatments to ensure an adequate perfusion in the ischemic tissue. However, after generalization of endovascular treatment (EVT) the rate of successful recanalization has skyrocketed and it is not well established if, once achieved, BP control should be stricter given its potential risks. We aim to explore the relation between BP and outcome among patients who underwent EVT. Methods: This is a retrospective study of a prospectively acquired unicentric database that includes patients who underwent EVT with successful recanalization measured by a mTICI ≥2b. Hourly measuring of systolic and diastolic BP was conducted during the first 24 hours post-procedure. BP variation was measured using standard deviation (SD) and range. We explored the effects of BP on functional outcome at 3 months and safety variables. Results: The study included 351 subjects with a mean age of 72.7+/-13.1 and 51.6% were men. The 3-months mRS was ≤2 in 50.4% of patients, 66 subjects (19.2%) presented hemorrhagic transformation and 67 (19.1%) were dead in the 3-months follow-up period. Both systolic BP SD (15.6+/-9.9 vs. 12.9+/-4.3; p<0.01) and range (55.6+/-18.4 vs. 48.7+/-16.4; p<0.01) were higher among patients with bad functional outcome (mRS>2). Subjects with hemorrhagic transformation presented higher range of DBP (35.7+/-12.4 vs. 32.0+/-11.9; p=0.03) and SBP (56.8+/-17.0 vs. 51.4+/-18.1; p=0.03) and higher diastolic DBP SD (9.3+/-4.1 vs. 8.2+/-2.7; p<0.01). In a logistic regression analysis DBP SD predicted ICH (OR 1.11, CI 1.02-1.22, p=0.01) and SBP range emerged as a predictor of poor functional outcome (OR 0.97, CI 0.96-0.99, p<0.01). No differences were detected in regard to admission BP, maximal and minimal BP or mean arterial pressure. Conclusions: Major fluctuations in systolic and diastolic BP predict increased risk of hemorrhagic complications and poor functional outcome. Minimizing BP fluctuations may improve outcome of EVT patients after recanalization.

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Abstract P511: Optimal Blood Pressure Targets Following Successful Revascularization With Mechanical Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p511 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Phong T Vu ◽

Swarna Rajagopalan ◽

Jessica Frey ◽

Emily Hone ◽

Casey Jelsema ◽

...

Keyword(s):

Blood Pressure ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Hemorrhagic Transformation ◽

Adverse Outcomes ◽

Multivariable Logistic Regression Analysis ◽

Blood Pressure Targets ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Optimal Blood Pressure

Background/Objective: Blood pressure parameters for patients undergoing mechanical thrombectomy (MT) are not clearly defined. Prior studies have shown that higher maximum and mean systolic blood pressure (SBP) is associated with adverse outcomes. Our study sought to investigate the relationship of blood pressure on clinical outcomes after successful revascularization and determine optimal thresholds for BP parameters that correlated with a poor functional outcome. Methods: This was a retrospective observational study of 88 consecutive patients who received successful MT at one comprehensive stroke center. Systolic, diastolic, and mean arterial pressure values were recorded for each patient over a 48-hour period, as well as patient age and National Institutes of Health Stroke Scale (NIHSS). Outcome measures included modified Rankin Score (mRS), intracranial hemorrhage (ICH), and mortality at time of discharge and 90 days. Both univariable and multivariable logistic regression analysis was performed to identify associations between the BP covariates and functional outcomes. Results: A higher SBP standard deviation (SD) of >14mmHg (OR=1.150) and wider SBP range >64mmHg (OR=1.037) from the mean in the first 48 hours after successful MT were associated with poor MRS at 90 days. A SBP SD>14 was also associated with mortality at 90 days. A higher age (OR=1.052) and NIHSS (OR=1.096) were also associated with a poor MRS at 90 days. A higher DBP mean (OR=1.045) was associated with a higher rate of hemorrhagic transformation (HT). Conclusions: A higher SBP variability within the first 48 hours after successful MT is associated with a higher likelihood of poor 90-day functional outcome and mortality, and a higher mean DBP is associated with a higher rate of HT.

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Time-dependent shift of the relationship between systolic blood pressure and clinical outcome in acute lacunar stroke

International Journal of Stroke ◽

10.1177/17474930211006243 ◽

2021 ◽

pp. 174749302110062

Author(s):

Dong W Shin ◽

Philip B Gorelick ◽

Hee-Joon Bae ◽

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Functional Outcome ◽

Linear Models ◽

Stroke Onset ◽

Time Dependent ◽

Lacunar Stroke ◽

Stroke Patients ◽

Poor Functional Outcome ◽

The Relationship

Background and aims This study explores the relationship between systolic blood pressure during the acute period of stroke and poor functional outcome in patients with lacunar stroke, emphasizing a possible time-dependent nature of the relationship. Methods Based on multicenter stroke registry data, patients with acute lacunar stroke were identified, and systolic blood pressure levels at eight time points (1, 2, 4, 8, 16, 24, 48, and 72 h) after stroke onset were extracted at the 15 participating centers in South Korea. Poor functional outcome was defined as a three-month modified Rankin Scale score of 2–6. Non-linear restricted cubic spline and linear models were used for assessing the relationship at each time point. Results A total of 97,349 systolic blood pressure measurements of 3,042 patients were analyzed. At 1 h and 4 h after stroke onset, the relationship between systolic blood pressure and poor outcome showed a non-linear association. The nadir was 155 mmHg at 1 h and 124 mmHg at 4 h. After this time period, a higher systolic blood pressure was associated with a poorer outcome. This linear relationship weakened over time after 12 h (coefficient values of the adjusted linear models: 0.0081 at 8 h, 0.0105 at 12 h, 0.0102 at 24 h, 0.0082 at 48 h, 0.0054 at 72 h). Conclusions Based on our cohort of large number of lacunar stroke patients, our findings suggest that systolic blood pressure levels may follow a time-dependent course in relation to prediction of outcome at three months. The findings may be valuable for hypothesis generation in association with clinical trial development for blood pressure control in acute stroke patients.

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SYSTOLIC BLOOD PRESSURE VARIABILITY DURING MECHANICAL THROMBECTOMY IS ASSOCIATED WITH EARLY NEUROLOGICAL DETERIORATION IN ACUTE ISCHEMIC STROKE PATIENTS

10.26226/morressier.58e389aed462b80292385662 ◽

2017 ◽

Author(s):

João Pedro Marto

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Systolic Blood Pressure ◽

Acute Ischemic Stroke ◽

Blood Pressure Variability ◽

Mechanical Thrombectomy ◽

Neurological Deterioration ◽

Stroke Patients ◽

Early Neurological Deterioration ◽

Systolic Blood Pressure Variability

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First attempt recanalization with ADAPT: rate, predictors, and outcome

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014294 ◽

2018 ◽

Vol 11 (7) ◽

pp. 641-645 ◽

Cited By ~ 11

Author(s):

Mohammad Anadani ◽

Ali Alawieh ◽

Jan Vargas ◽

Arindam Rano Chatterjee ◽

Aquilla Turk ◽

...

Keyword(s):

Functional Outcome ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Hemorrhagic Transformation ◽

Lower Mortality ◽

Anterior Circulation ◽

Tandem Occlusion ◽

First Pass ◽

Baseline Characteristics ◽

Iv Tpa

IntroductionThe rate of first-attempt recanalization (FAR) with the newer-generation thrombectomy devices, and more specifically with aspiration devices, is not well known. Moreover, the effect of FAR on outcomes after mechanical thrombectomy is not properly understood.ObjectiveTo report the rate of FAR using a direct aspiration first pass technique (ADAPT), investigate the association between FAR and outcomes, and identify the predictors of FAR.MethodsThe ADAPT database was used to identify a subgroup of patients in whom FAR was achieved. Baseline characteristics, procedural, and postprocedural variables were collected. Outcome measures included 90-day modified Rankin scale (mRS) score, mortality, and hemorrhagic complications. Multivariate logistic regression was used to identify FAR predictors.ResultsA total of 524 patients was included of whom 178 (34.0%) achieved FAR. More patients in the FAR group than in the non-FAR group received IV tPA (46.6% vs 37.6%; p<0.05). For the functional outcome, higher proportions of patients in the FAR group achieved functional independence (mRS score 0–2; 53% vs 37%; p<0.05). Additionally, we observed lower mortality and hemorrhagic transformation rates in the FAR group than the non-FAR group. Independent predictors of FAR in the anterior circulation were pretreatment IV tPA, non-tandem occlusion, and use of larger reperfusion catheters (Penumbra, ACE 64–68). Independent predictors of FAR in the posterior circulation were diabetes, onset-to-groin time, and cardioembolic etiology.ConclusionFAR was associated with better functional outcome and lower mortality rate. When ADAPT is used, a larger aspiration catheter and pretreatment IV tPA should be employed when indicated.

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Abstract MP33: Association Between Neurologic Outcomes and Temporal Profile of Systolic Blood Pressure Variability After Endovascular Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.mp33 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ayush Prasad ◽

Jessica Kobsa ◽

Sreeja Kodali ◽

Cindy Khanh Nguyen ◽

Darko Quispe Orozco ◽

...

Keyword(s):

Blood Pressure ◽

Standard Deviation ◽

Systolic Blood Pressure ◽

Functional Outcome ◽

Blood Pressure Variability ◽

Treatment Strategies ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Increased Risk ◽

Systolic Blood Pressure Variability

Introduction: Higher systolic blood pressure variability (BPV) after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and worse functional outcomes. However, the time-varying behavior of BPV after EVT and its effects on functional outcome have not been well characterized. Methods: We analyzed data from an international cohort of patients with acute large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Parameters of BPV were calculated in 12-hour epochs using five established methodologies: standard deviation (SD), coefficient of variation (CV), average real variability (ARV), successive variation (SV), and residual SD (rSD). Patients’ overall mean BPV was then used to assign patients into tertiles for regression analysis: low BPV, intermediate BPV, and high BPV. Functional outcome was measured with the modified Rankin Scale (mRS) at 90 days. Results: Of the 1,791 patients (age 69 ± 14, NIHSS 15 ± 6) included in our analysis, 1,085 (60.6%) had a poor 90-day outcome (mRS >3). Patients with poor outcome had significantly higher systolic BPV (p<0.05) measured as standard deviation (SBP SD) at each epoch (Figure 1B). Compared to patients with low BPV, those in the highest tertile group had significantly greater odds of a poor functional outcome after adjusting for age, sex, hypertension, NIHSS, ASPECT, tPA, time to reperfusion, and TICI score (OR 1.5; 95% CI 1.2-2; p=0.001). Patients in the highest tertile of BPV demonstrated time-dependent variability with the highest SBP SD during the first 24 hours after thrombectomy (Figure 1A). Conclusions: Higher BPV measured by SBP SD appears to be associated with poor 90-day outcome in EVT-treated stroke patients. Early treatment strategies targeting early high BPV warrant further prospective investigation.

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Abstract TP19: Charlson Comorbidity Index Predicts Mortality and Functional Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽

10.1161/str.47.suppl_1.tp19 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Daniela Samaniego ◽

Maria Hernandez-Perez ◽

Anna Planas ◽

Lorena Martin ◽

Laura Dorado ◽

...

Keyword(s):

Ischemic Stroke ◽

Functional Outcome ◽

Charlson Comorbidity Index ◽

Mechanical Thrombectomy ◽

Stroke Severity ◽

Stroke Patients ◽

Poor Functional Outcome ◽

Arterial Revascularization ◽

Comorbidity Index ◽

High Comorbidity

Introduction: Despite mechanical thrombectomy has achieved a dramatic improvement on ischemic stroke prognosis, up to 50% of patients treated with this approach do not have good functional outcome. Besides age and baseline infarct core, comorbidity might play a role in stroke prognosis. We aim to study the capacity of Charlson comorbidity index (CCI) in predicting mortality and functional outcome in acute ischemic stroke patients who underwent mechanical thrombectomy. Methods: We studied 228 consecutive patients (59% male, mean age 65y) with acute anterior circulation arterial occlusion treated with stent retrievers between May 2009 and March 2015. Demographical data, stroke severity, ASPECTS score at baseline and medical conditions included in the CCI were collected and CCI score was calculated retrospectively. We considered low comorbidity if CCI score was <2 and high comorbidity if CCI score was ≥2. Complete arterial revascularization was defined as a TICI ≥2b on final angiographic run. Good functional outcome was defined as a modified Rankin score ≤2 at 90 days. Results: The CCI was 0 in 47% of patients, 1 in 23%, 2 in 15%, 3 in 10% and ≥4 in 5%. CCI of 2 or more was associated with poor functional outcome (70.6% vs 50%, p = 0.004) and mortality (33.8% vs. 11.7%, p <0.001) compared to patients with low CCI. In a logistic regression adjusted by stroke severity, age, ASPECTS score at baseline and arterial revascularization, high comorbidity remained as an independent predictor of poor outcome (OR 2.9; 95% CI 1.4-5.8) and mortality (OR 4.6, 95% CI 2.0-10.3). Conclusions: High comorbidity assessed by Charlson Comorbidity Index is associated with poor functional outcome and mortality in acute stroke patients treated with mechanical thrombectomy.

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