Abstract WP125: Association of 24-Hour Systolic Blood Pressure Parameters Post-Intravenous Alteplase With Functional Outcomes at Discharge

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Taha Nisar ◽  
Toluwalase Tofade ◽  
Ava Liberman ◽  
Priyank Khandelwal
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Functional Outcome ◽  
Pulse Pressure ◽  
Compensatory Mechanism ◽  
Good Outcome ◽  
Poor Outcome ◽  
Intravenous Alteplase ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: Elevation of post-stroke systolic blood pressure (SBP) can be a part of a compensatory mechanism to restore cerebral perfusion to the ischemic brain tissue, but comes at a risk of reperfusion injury. The ideal SBP in the 24-hour range post-IV-rtPA has been understudied. We investigated the association of different SBP parameters post-intravenous-alteplase (IV-rtPA) with the functional outcome at discharge at a tertiary care center. Methods: We performed a retrospective chart review of patients with an acute ischemic stroke treated with IV-rtPA at a comprehensive stroke center from July 2014 to March 2018. We excluded patients who underwent mechanical thrombectomy. At the comprehensive stroke center, the BP values are documented according to standard post-IV-rtPA care guidelines. We recorded the SBP values over a period of 24-hours post-IV-rtPA. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment NIHSS, atrial fibrillation, onset to treatment time, with the SBP parameters as the predictors. The primary outcome was the functional outcome at discharge. Good outcome was defined as a modified rankin scale (mRS) of ≤2 and a poor outcome as mRS of ≥3, upon discharge. Results: 84 patients met our inclusion criteria. 45 (53.57%) patients were male. The mean age was 63.50±15 years. 25 (29.76%) patients had a good outcome (mRS≤2) at discharge. In our cohort, the parameters of higher mean SBP (144.9±14 vs.135.5±18; OR, 1.06; 95% CI, 1.02-1.11; P 0.004), higher maximum SBP (176.56±17 vs.166.7±18; OR, 1.06; 95% CI, 1.02-1.1; P 0.005) and wider pulse pressure (65.5±12 vs.57.8±13; OR,1.08; 95% CI, 1.03-1.14; P 0.007) were significantly associated with a poor outcome at discharge. Parameters of SBP variability like standard deviation SBP (13.5±5 vs.11.5±4; OR, 1.17; 95% CI, 1-1.36; P 0.058), coefficient variation SBP (9.36±4 vs.8.49±3; OR, 1.11; 95% CI, 0.94-1.32; P 0.242), and SBP range (62.22±20 vs.54.68±15; OR, 1.04; 95% CI, 1-1.07; P 0.08) were not significantly associated with a poor outcome at discharge. Conclusions: Our study demonstrates an association between higher mean SBP, higher maximum SBP, and wider pulse pressure over a period of 24-hours post-IV-rtPA, and poor functional outcome upon discharge.

Abstract WP331: Does Successful Reperfusion Mean Successful Outcome in Elderly Stroke Patients?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amber N Ruiz ◽  
Agnelio Cardentey ◽  
WT Longstreth ◽  
David L Tirschwell ◽  
Claire J Creudtzfeldt
Keyword(s):  
Elderly Patients ◽  
Functional Outcome ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Successful Outcome ◽  
Good Outcome ◽  
Single Center Experience ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Randomized clinical trials (RCTs) suggest a benefit of mechanical thrombectomy (MT) even for individuals ≥ 80 years of age; however, this population has not been consistently included in RCTs, and the eldest (≥85 years) are underrepresented. Small observational studies suggest that elderly patients experience a higher proportion of in-hospital complications, mortality, and poor functional outcome defined as modified Rankin Scale Score (mRS) ≥4. While MT is generally recommended in this population, little is known about how decisions are made to undergo MT or subsequently to withdraw or withhold life-sustaining treatments (WoLST). The goal of this study was to describe a single center experience of elderly patients who underwent MT. Methods: We identified all patients admitted to our comprehensive stroke center from June 2016 - June 2018 who were ≥85 years old and underwent successful MT, defined as TICI 2a to 3. We collected data from the electronic medical record, including WoLST. A good outcome was defined as a mRS of 0-2 at 90 days. Results: We identified a total of 29 patients with successful MT with a mean age of 88.4 years (SD=3.6); 66% were women. Only one patient (3.4%) achieved a good outcome, while 65.5% died (see figure). Among decedents, 47.4% expired during their initial hospitalization, while 15.8% were discharged to hospice. A decision for WoLST was made in 11 patients, 88.9% of in-hospital decedents. Discussion: In our retrospective study of 29 elderly patients who underwent successful MT, only one achieved good functional outcome, and most died in the setting of WoLST. These observations may raise the question about the appropriateness of MT in this cohort, emphasizing the need for further research aimed (1) to identify determinants of outcome and MT success specific to elderly MT candidates and (2) to better understand the process of clinical decision making for this growing, vulnerable population of elderly patients.

Abstract MP35: Blood Pressure Reductions Before Arrival at a Thrombectomy-Capable Hospital Are Associated With Neurologic Worsening in Patients With Large-Vessel Occlusion

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jessica Kobsa ◽  
Ayush Prasad ◽  
Alexandria Soto ◽  
Sreeja Kodali ◽  
Cindy Khanh Nguyen ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Management Strategies ◽  
Vessel Occlusion ◽  
Time Points ◽  
Good Outcome ◽  
Primary Stroke Center ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Radiographic Data

Introduction: Decreases in blood pressure (BP) during thrombectomy are associated with infarct progression and worse outcomes. Many patients present first to a primary stroke center (PSC) and are later transferred to a comprehensive stroke center (CSC) to undergo thrombectomy. During this period, important BP variations might occur. We evaluated the association of BP reductions with neurological worsening and functional outcomes. Methods: We prospectively collected hemodynamic, clinical, and radiographic data on consecutive patients with LVO ischemic stroke who were transferred from a PSC for possible thrombectomy between 2018 and 2020. We assessed systolic BP (SBP) and mean arterial pressure (MAP) at five time points: earliest recorded, average pre-PSC, PSC admission, average PSC, and CSC admission. We measured neurologic worsening as a change in NIHSS (ΔNIHSS) from PSC to CSC >3 and functional outcome using the modified Rankin Scale (mRS) at discharge and 90 days. Relationships between variables of interest were evaluated using linear regression. Results: Of 91 patients (mean age 70±16 years, mean NIHSS 12) included, 13 (14%) experienced early neurologic deterioration (ΔNIHSS>3), and 34 (37%) achieved a good outcome at discharge (mRS<3). We found that patients with good outcome had significantly lower SBP at all five assessed time points compared to patients with poor outcome (Figure 1, p<0.05). Percent change in MAP from initial presentation to CSC arrival was independently associated with ΔNIHSS after adjusting for age, sex, and transfer time (p=0.03, β=0.27). Conclusions: Patients with poor outcomes have higher BP throughout the pre-CSC period, possibly reflecting an augmented hypertensive response. Reductions in SBP and MAP before arrival at the CSC are associated with neurologic worsening. These results suggest that BP management strategies in the pre-CSC period to avoid large reductions in BP may improve outcomes in patients affected by LVO stroke.

Abstract WP126: Association of 24-Hour Blood Pressure Parameters Post-Intravenous Alteplase With Symptomatic Intracerebral Hemorrhage

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Taha Nisar ◽  
Toluwalase Tofade ◽  
Ava Liberman ◽  
Priyank Khandelwal
Keyword(s):  
Blood Pressure ◽  
Intracerebral Hemorrhage ◽  
Treatment Time ◽  
Tertiary Care ◽  
Significant Risk ◽  
Binary Logistic Regression Analysis ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Intravenous Alteplase ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: Higher blood pressure (BP) at presentation is associated with a higher risk of symptomatic intracerebral hemorrhage (sICH) post-intravenous alteplase (IV-rtPA). We investigated the association of different BP parameters post-IV-rtPA with the development of sICH at a tertiary care center. Methods: We performed a retrospective chart review of adult patients with an acute ischemic stroke treated with IV-rtPA at a comprehensive stroke center from July 2014 to March 2018. We excluded patients who underwent mechanical thrombectomy. At the comprehensive stroke center, the BP values are documented according to standard post-IV-rtPA care guidelines. We recorded the BP values over a period of 24-hours post-IV-rtPA. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment NIHSS, atrial fibrillation, onset to treatment time, with the BP parameters as the predictors. The primary outcome was the development of sICH. SICH was defined as an intracerebral hemorrhage (ICH) that causes worsening of NIHSS score by ≥4 points post-IV-rtPA. Results: 84 patients met our inclusion criteria. 45 (53.57%) patients were male. The mean age was 63.50±15 years. 5 (5.95%) patients developed sICH. In our cohort, the BP parameters of higher maximum systolic blood pressure (SBP) (195.8±9 vs.172.22±17; OR, 1.14; 95% CI, 1.03-1.26; P 0.016), higher maximum diastolic blood pressure (DBP) (120.2±18 vs.104.76±15; OR, 1.08; 95% CI, 1.01-1.17; P 0.04), wider SBP range (79.4±20 vs.58.75±18; OR, 1.06; 95% CI, 1.01-1.12; P 0.033), wider DBP range (74.2±27 vs.47.27±15; OR, 1.11; 95% CI, 1.03-1.2; P 0.008), and coefficient variation (CV) DBP (17.7±6 vs.12.65±4; OR, 1.19; 95% CI, 1.01-1.42; P 0.048) were significantly associated with a risk of sICH post IV-rtPA. Conclusions: Our study demonstrates significant risk of sICH with higher maximum SBP and DBP, wider SBP and DBP ranges, and CV DBP post-IV-rtPA.

Abstract 1122‐000123: Association of 24‐hour Blood Pressure Parameters Post‐Thrombectomy with Functional Outcomes According to Collateral Status

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Taha Nisar ◽  
Toluwalase Tofade ◽  
Konrad Lebioda ◽  
Osama Abu‐Hadid ◽  
Priyank Khandelwal
Keyword(s):  
Blood Pressure ◽  
Functional Outcome ◽  
Retrospective Chart Review ◽  
Binary Logistic Regression ◽  
Binary Logistic Regression Analysis ◽  
Good Functional Outcome ◽  
Ct Angiogram ◽  
Ischemic Brain Tissue ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction : Higher blood pressure (BP) most post mechanical thrombectomy (MT) can restore perfusion to the ischemic brain tissue depending on collateral status. We aim to determine the association of 24‐hour post‐MT BP parameters with the functional outcome 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 two groups (good versus bad) depending on collateral status. A board‐certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading scales of Mass ≥3 and modified‐Tan>50% to designate good collaterals on the pre‐MT CT Angiogram. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, time to thrombectomy, LDL, Hemoglobin‐A1C, intravenous‐alteplase, with the 24‐hour post‐MT BP parameters as the predictors. The outcomes were good functional outcome (3‐month mRS≤2) and mortality. Results : 220 patients met the inclusion criteria. 24‐hour BP parameters of standard deviation (SD) SBP (OR, 1.16; 95% CI,1.01‐1.33; P 0.047) and maximum DBP (OR, 1.05; 95% CI,1.01‐1.09; P 0.036) had an association with a good functional outcome, while SD SBP (OR, 1.15; 95% CI,1.01‐1.31; P 0.045), coefficient variation (CV) SBP (OR, 1.19; 95% CI,1.01‐1.41; P 0.043), SBP range (OR, 1.04; 95% CI,1.01‐1.07; P 0.046), maximum DBP (OR, 0.95; 95% CI,0.91‐0.99; P 0.016), pulse pressure (OR, 1.09; 95% CI,1.02‐1.16; P 0.022) and SBP ≥140 (OR, 5.85; 95% CI,1.11‐30.85; P 0.038) had an association with mortality in patients with good collaterals according to Mass grading. 24‐hour BP parameters of SD SBP (OR, 1.13; 95% CI,1.04‐1.24; P 0.007), CV SBP (OR, 1.18; 95% CI,1.05‐1.32; P 0.006), SBP range (OR, 1.04; 95% CI,1.01‐1.06; P 0.008) and maximum DBP (OR, 0.97; 95% CI,0.94‐1; P 0.02) had an association with mortality in patients with good collaterals according to modified‐Tan grading. There was no such association in patients with bad collaterals Conclusions : Various 24‐hour BP parameters post‐MT are associated with a functional outcome or mortality in patients with good collaterals, unlike in patients with bad collaterals.

Abstract TP42: Association of 24-Hour Blood Pressure Parameters Post-Thrombectomy With Functional Outcomes at Discharge

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Taha Nisar ◽  
Toluwalase Tofade ◽  
Ava Liberman ◽  
Priyank Khandelwal
Keyword(s):  
Blood Pressure ◽  
Logistic Regression ◽  
Functional Outcome ◽  
Functional Outcomes ◽  
Care Center ◽  
Tertiary Care ◽  
Binary Logistic Regression Analysis ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Mean

Introduction: Elevation of blood pressure (BP) post mechanical thrombectomy (MT) can theoretically restore cerebral perfusion to the ischemic brain tissue, but it comes at a risk of causing reperfusion injury. The ideal BP in the 24-hour range after MT has been understudied. We investigated the association of different BP parameters post-MT with the functional outcome at discharge at a tertiary care center. Methods: We performed a retrospective chart review of adult patients who underwent MT for an anterior circulation large vessel occlusion at a comprehensive stroke center from July 2014 to March 2018. We recorded the BP values over a period of 24-hours post-MT. A binary logistic regression analysis was performed, controlling for age, pre-thrombectomy NIHSS-scores, thrombolysis in cerebral infarction (TICI)-scores, duration to thrombectomy, with the BP parameters as the predictors. The primary outcome was the functional outcome at discharge. Good outcome was defined as a modified rankin scale (mRS) of 0-2 and a poor outcome as mRS of 3-6, upon discharge. Results: 69 patients met our inclusion criteria. 39 (56.52%) patients were male. The mean age was 64.80±14 years. The mean pre-treatment NIHSS was 16.18±5. 22 (31.88%) patients had a good outcome (mRS≤2) at discharge. In the logistic regression model, the parameters of higher mean arterial pressure (MAP) variability like coefficient variation (CV) MAP (7.04±6 vs.3.13±5.; OR, 1.13; 95% CI,1.01-1.27; P 0.038) and standard deviation (SD) MAP (6.4±6 vs.2.75±4; OR, 1.15; 95% CI,1.02-1.31; P 0.032) were significantly associated with a poor outcome at discharge. The parameters of average systolic BP, average diastolic BP, and average MAP over 24-hours post-MT were not significantly associated with poor outcomes at discharge. Conclusions: Our study demonstrates a significant association between 24-hours-post-MT parameters of higher MAP variability like CV MAP and SD MAP and poor functional outcomes at discharge.

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

Stroke ◽  
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.

scholarly journals Evaluation of Clinical Variables Associated with Increased Carotid Intima-Media Thickness in Middle-Aged Hypertensive Women

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Michelle Trindade ◽  
Renata Brum Martucci ◽  
Adriana K. Burlá ◽  
Wille Oigman ◽  
Mario Fritsch Neves ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Systolic Blood Pressure ◽  
Pulse Pressure ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Independent Variables ◽  
Vascular Ultrasound ◽  
Media Thickness

It has been previously documented that carotid intima-media thickness (cIMT) is a predictor of cardiovascular disease. The aim of this study was to identify clinical parameters associated with an increased cIMT treated hypertensive women. Female patients (n=116) with essential hypertension, aged 40–65 years, were included in this study. Vascular ultrasound was performed and the patients were divided into two groups according to the values of cIMT (< or ≥0.9 mm). Patients with greater cIMT presented significantly higher systolic blood pressure and pulse pressure. Serum HDL-cholesterol was significantly lower and CRP was significantly higher in the same group. There was a significant correlation between cIMT and age (r=0.25,P=0.007), systolic blood pressure (r=0.19,P=0.009), pulse pressure (r=0.30,P=0.001), and LDL-cholesterol (r=0.19,P=0.043). cIMT was correlated to CRP (r=0.31,P=0.007) and negatively correlated to HDL-cholesterol (r=0.33,P=0.001). In logistic regression, only HDL-cholesterol, CRP, and pulse pressure were shown to be independent variables associated to increased cIMT. In conclusion, pulse pressure, HDL-cholesterol, and CRP are variables correlated with cIMT in treated hypertensive women.

How do treatment times impact on functional outcome in stroke patients undergoing thrombectomy in Germany? Results from the German Stroke Registry

2021 ◽  
pp. 174749302098526
Author(s):  
Juliane Herm ◽  
Ludwig Schlemm ◽  
Eberhard Siebert ◽  
Georg Bohner ◽  
Anna C Alegiani ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Stroke Patients ◽  
Poor Functional Outcome ◽  
Stroke Registry ◽  
Primary Stroke Center ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Center Time

Background Functional outcome post-stroke depends on time to recanalization. Effect of in-hospital delay may differ in patients directly admitted to a comprehensive stroke center and patients transferred via a primary stroke center. We analyzed the current door-to-groin time in Germany and explored its effect on functional outcome in a real-world setting. Methods Data were collected in 25 stroke centers in the German Stroke Registry-Endovascular Treatment a prospective, multicenter, observational registry study including stroke patients with large vessel occlusion. Functional outcome was assessed at three months by modified Rankin Scale. Association of door-to-groin time with outcome was calculated using binary logistic regression models. Results Out of 4340 patients, 56% were treated primarily in a comprehensive stroke center and 44% in a primary stroke center and then transferred to a comprehensive stroke center (“drip-and-ship” concept). Median onset-to-arrival at comprehensive stroke center time and door-to-groin time were 103 and 79 min in comprehensive stroke center patients and 225 and 44 min in primary stroke center patients. The odds ratio for poor functional outcome per hour of onset-to-arrival-at comprehensive stroke center time was 1.03 (95%CI 1.01–1.05) in comprehensive stroke center patients and 1.06 (95%CI 1.03–1.09) in primary stroke center patients. The odds ratio for poor functional outcome per hour of door-to-groin time was 1.30 (95%CI 1.16–1.46) in comprehensive stroke center patients and 1.04 (95%CI 0.89–1.21) in primary stroke center patients. Longer door-to-groin time in comprehensive stroke center patients was associated with admission on weekends (odds ratio 1.61; 95%CI 1.37–1.97) and during night time (odds ratio 1.52; 95%CI 1.27–1.82) and use of intravenous thrombolysis (odds ratio 1.28; 95%CI 1.08–1.50). Conclusion Door-to-groin time was especially relevant for outcome of comprehensive stroke center patients, whereas door-to-groin time was much shorter in primary stroke center patients. Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03356392 . Unique identifier NCT03356392

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