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.

Abstract 1122‐000091: Predictors of Symptomatic Hemorrhagic Transformation After Mechanical Thrombectomy in Acute Ischemic Stroke

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Anqi Luo ◽  
Agnelio Cardenas ◽  
Lee A Birnbaum
Keyword(s):  
Risk Factors ◽  
Mechanical Thrombectomy ◽  
Standard Of Care ◽  
Hemorrhagic Transformation ◽  
Current Standard ◽  
Vessel Occlusion ◽  
Increased Risk ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa

Introduction : Mechanical thrombectomy (MT) has become the current standard of care for large vessel occlusion stroke but is associated with an increased risk of intracranial hemorrhage (ICH). Although several studies have investigated the risk factors, there is still limited, not well‐established data. This study aims to evaluate the risk factors of HT after MT. Methods : We retrospectively reviewed all MT patients who were treated at a single comprehensive stroke center from 12/2016 to 7/2019. Variables included initial NIHSS, blood glucose, initial systolic blood pressure, age, gender, IV tPA, time from door to recanalization, and TICI score. Outcome measures were HT on post‐procedure or 24‐hour post‐tPA head CT/MRI as well as modified Rankin scale (mRS) upon discharge. Results : Among 74 patients (68.8 ± 14 years, men 47.3%), 9 (12.2%) experienced hemorrhagic transformation after thrombectomy. Average admitting NIHSS was significantly higher in the HT group (22 vs 16.8, p = 0.041). TICI 3 after MT was protective for HT (OR 0.078, 95% CI 0.009‐0.663). IV tPA (OR 3.86, 95% CI 1.448‐10.326) was associated with good neurological outcome at discharge (mRS < = 2), but HT was not (OR 0.114, 95% CI 0.013‐0.964). Patients with mRS < = 2 upon discharge were younger (65.2±12 vs 71.9±15, p = 0.04) and had lower initial BG (124±45.8 vs 157±69.6, P = 0.02). Conclusions : TICI 3 score, decreased NIHSS, and lower BG were associated with less HT and better outcomes in our MT cohort. Admitting NIHSS > = 20 may be a reasonable threshold to predict HT after MT. Our findings are consistent with the TICI‐ASPECTS‐glucose (TAG) score to predict sICH; however, we used initial NIHSS as a surrogate for ASPECTS. Further studies may utilize additional quantitative measures such as CTP data to predict HT.

scholarly journals Association of Personalized Blood Pressure Targets With Hemorrhagic Transformation and Functional Outcome After Endovascular Stroke Therapy

2019 ◽  
Vol 76 (10) ◽  
pp. 1256 ◽  
Author(s):  
Nils H. Petersen ◽  
Andrew Silverman ◽  
Anson Wang ◽  
Sumita Strander ◽  
Sreeja Kodali ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Functional Outcome ◽  
Hemorrhagic Transformation ◽  
Stroke Therapy ◽  
Blood Pressure Targets ◽  
Endovascular Stroke Therapy

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 WMP89: Outcomes No Different in Real World Including Direct vs Drip-and-Ship Patients: Power of Reperfusion From Mechanical Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Darshan G Shah ◽  
Aravi Loganathan ◽  
Dan Truong ◽  
Fiona Chan ◽  
Bruce Campbell ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Real World ◽  
Functional Outcomes ◽  
Mechanical Thrombectomy ◽  
Vessel Occlusion ◽  
Excellent Functional Outcome ◽  
The Mean ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Mechanical thrombectomy (MT) became standard care in 2015 after positive trials in patients presenting with acute ischemic stroke and large vessel occlusion (LVO) 0-6h and in 2018 for selected patients up to 24h from symptom onset. Objective: To evaluate whether patients receiving MT at our center would have comparable outcomes in patients presenting to our comprehensive stroke center (direct) vs transfer patients (drip-and-ship) Methods: This is a retrospective observational study utilising prospectively collected stroke database for patients receiving MT for LVO in anterior and posterior circulation in South Brisbane network of 7 hospitals (6 drip-and-ship centers and 1 MT-capable center), Australia which serves 1.6 million. Day 90 modified Rankin scale (mRS) was used to assess functional outcomes via outpatient follow up at direct or referral center. The association of drip and ship versus mothership treatment with day 90 mRS was tested in ordinal logistic regression adjusted for age, baseline NIHSS and IV thrombolysis. Results: Of 191 patients who underwent Mechanical Thrombectomy from 2015 to June 2018 at our center, 22 patients were excluded from analysis as either their baseline mRS was >1 (13) or follow up data was missing (9). The mean age was 64.4 years. Median (inter-quartile range, IQR) NIHSS was 16 (9-21) on admission and 7 (2-18) on day 1. Thrombolysis in Cerebral Infarction (TICI) ≥2b was achieved in 88.9%. At 90 days, 50.9% achieved excellent functional outcome (mRS 0-1), 61.4% achieved good functional outcome (mRS 0-2) and 69% achieved favorable outcome (mRS 0-3). Median mRS was 1 (IQR 0-5) in 96 patients presenting directly to the endovascular center and 1 (IQR 1-4) in 73 drip-and-ship patients (common odds ratio 1.07 (95%CI 0.62-1.83), p=0.82) Conclusion: Our 7-center network experience confirms real world reproducibility of trial results, interestingly with no difference in functional outcomes for direct vs drip-and-ship patients.

Abstract P469: Device-Related Dimensions and Their Effect on First Pass Success and Safety Outcomes After Mechanical Thrombectomy: Is Longer Safer?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mahmoud Dibas ◽  
Sohum Desai ◽  
WONDWOSSEN TEKLE ◽  
Sherief Ghozy ◽  
Adam A Dmytriw ◽  
...  
Keyword(s):  
Mechanical Thrombectomy ◽  
Mass Effect ◽  
Mortality Rates ◽  
Hemorrhagic Transformation ◽  
Symptomatic Intracerebral Hemorrhage ◽  
First Pass ◽  
Safety Outcomes ◽  
The Mean ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: Mechanical thrombectomy (MT) results in a marked improvement in outcomes of acute ischemic stroke (AIS) patients. First pass effect (FPE), which is defined as the achievement of complete recanalization (mTICI 3) from a single pass, appears to be associated with higher rates of good outcome. We seek to determine if dimensions of stentreivers such as length and diameter have influence on FPE, and other safety outcomes including hemorrhagic transformation, symptomatic intracerebral hemorrhage (sICH), masseffect, and mortality. Methodology: Patients who underwent MT between 2012 and 2020 were identified from a prospectively maintained database at a comprehensive stroke center. Then, these patients were stratified based on dimensions of stentrievers into: "4x20", "4x40", "6x30", and “6x40". Stentrievers used during the study period included Trevo and Solitare. Results: This study included 320 AIS patients. The mean (SD) age of the included patients was 70.7 (13.5), and 54.1% of them were males. 79 (24.7%) of the stentrievers were 4x20, 47 (14.7%) were 4x40, 66 (20.6%) were 6x30, while 128 (40%) were 6x40. There was no difference among the four stentreivers in FPE rates (64.6% vs 68.1%, 66.7%, 67.2%, p=0.98), hemorrhagic transformation (10.1% vs 14.9%, 12.1%, 14.8%, p=0.88), mass effect (3.8% vs 6.4%, 9.1%, 11.7%, p=0.134), and mortality rates (17.7% vs 23.7%, 19.7%, 20.3%, p=0.86). Noteworthy, sICH was significantly different among the groups with the lowest rates reported for 4x40 (4.3%) and 6x40 (5.5%), followed by 4x20 (10.1%), and 6x30 (16.7%), respectively (p=0.04). Conclusions: Stentriever dimensions do not appear to significantly influence FPE rates. We found that 4x40 and 6x40 stentrievers were significantly associated with lower rates of sICH.

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.

scholarly journals Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
You-Bin Lee ◽  
Ji Sung Lee ◽  
So-hyeon Hong ◽  
Jung A. Kim ◽  
Eun Roh ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Cardiovascular Events ◽  
Antihypertensive Treatment ◽  
Antihypertensive Agents ◽  
Population Based ◽  
Adverse Outcomes ◽  
Optimal Blood Pressure ◽  
Stage Renal Disease

AbstractThe effect of blood pressure (BP) on the incident cardiovascular events, progression to end-stage renal disease (ESRD) and mortality were evaluated among chronic kidney disease (CKD) patients with and without antihypertensive treatment. This nationwide study used the Korean National Health Insurance Service-Health Screening Cohort data. The hazards of outcomes were analysed according to the systolic BP (SBP) or diastolic BP (DBP) among adults (aged ≥ 40 years) with CKD and without previous cardiovascular disease or ESRD (n = 22,278). The SBP and DBP were ≥ 130 mmHg and ≥ 80 mmHg in 10,809 (48.52%) and 11,583 (51.99%) participants, respectively. During a median 6.2 years, 1271 cardiovascular events, 201 ESRD incidents, and 1061 deaths were noted. Individuals with SBP ≥ 130 mmHg and DBP ≥ 80 mmHg had higher hazards of hypertension-related adverse outcomes compared to the references (SBP 120–129 mmHg and DBP 70–79 mmHg). SBP < 100 mmHg was associated with hazards of all-cause death, and composite of ESRD and all-cause death during follow-up only among the antihypertensive medication users suggesting that the BP should be < 130/80 mmHg and the SBP should not be < 100 mmHg with antihypertensive agents to prevent the adverse outcome risk of insufficient and excessive antihypertensive treatment in CKD patients.

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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