Blood Pressure After Endovascular Thrombectomy And Prognosis In Acute Large Vessel Occlusion Stroke With Anterior Circulation

Background and purposeEndovascular thrombectomy(EVT)has become the current standard of care for patients with large vessel occlusion stroke(LVOS)of the anterior circulation.Unfortunately,the optimal BP management after the endovascular procedure is currently unknown.Therefore,we performed a study in a multicenter cohort of Chinese patients with EVT.We aimed to investigate:(1)timeline of blood pressure(BP)changes after EVT and the association of mean blood pressure(MBP)with the 90-day functional outcome and symptomatic intracranial hemorrhage(sICH)after EVT;(2)the association of various blood pressure variability(BPV)parameters with the 90-day functional outcome and sICH;(3)the association of MBP level and BPV after thrombectomy with the development of malignant cerebral edema(MCE)in patients treated with EVT;(4)the association of BP reduction after EVT with the 90-day functional outcome and sICH.Methods Consecutive patients who underwent EVT for an anterior ischemic stroke were retrospective registered from 3 comprehensive stroke centers between 2014 and 2019.General clinical data and 24-hour blood pressure data were collected.We calculated MBP,BPV and BP reduction.BPV parameters were standard deviation(SD),coefficient of variation(CV),and successive variation(SV).BP reduction was defined as the difference between admission SBP and mean SBP in the first 24 hours.The outcomes included the 90-day functional outcome assessed by modified Rankin Scale score,symptomatic intracranial hemorrhage(sICH)and MCE.Univariate and logistic regression analysis were used to explore the correlation between blood pressure parameters and the outcomes after EVT.ResultsWe included 502 consecutive patients who underwent EVT due to anterior circulation LVOS.219(43.6%)achieved the good clinical outcome,59(11.8%)developed sICH and 97(19.5%)developed MCE.We found:(1)there was a decline in BP after EVT,and the decrease was more obvious in patients with recanalization.There was no statistical significance between MBP and the 90-day good functional outcome,regardless of the recanalization status.However,in patients with successful recanalization,higher mean systolic blood pressure(SBP)was significant associated with the increased rate of sICH(OR,1.041,P=0.037).(2)SBP variability,including CV(OR,1.089,P=0.035),SV(OR,1.082,P=0.004)and SD(OR,1.074,P=0.027),was associated with the poor clinical outcome.Additionally,higher SBP CV(OR,1.156,P=0.001)and SBP SD(OR,1.118,P=0.001)were significantly associated with increased odds of sICH.However,the correlation depends on the recanalization status.(3)elevated mean SBP(OR,1.035;P=0.017)was associated with a higher likelihood of MCE.Moreover,increases in BPV,as evaluated by SBP SD(OR,1.061;P=0.039),were associated with higher likelihood of MCE.(4)SBP reduction(OR,0.972,P=0.001)were significantly associated with lower odds of sICH and the relationship mainly occurred in the first 18 hours after EVT.There was no statistical significance between BP reduction and the 90-day functional outcome.Conclusions(1)There was a significant decline in BP after EVT.The decrease of BP did not affect the 90-day functional prognosis of patients,but reduced the occurrence of sICH after EVT.(2)Higher 24-hour MBP after EVT increased the incidence of sICH and MCE,but did not affect the 90-day functional prognosis.(3)Higher BPV after EVT was associated with poor 90-day functional prognosis and increased the incidence of sICH and MCE.