| BackgroundAcute ischemic stroke(AIS)is one of the leading causes of death and disability in adults around the world,placing a heavy burden on families and society.In Asian populations,intracranial artery occlusive disease is the most common cause of ischemic stroke,since 2015,a number of randomized clinical trials show that Endovascular treatment(Endovascular therapy,EVT)can greatly improve the former circulating vascular occlusion(anterior circulation large vessel occlusion,LVO)caused by acute cerebral blood reperfusion of ischemic cerebral apoplexy patients,Endovascular treatment can reach 67-88%of the rate of complete revascularization,However,despite successful opening,about half of patients do not regain functional independence after 3 months.The study of the optimal adjuvant treatment strategy for these patients is worthy of further exploration,in which the treatment strategy of perioperative blood pressure(BP)is crucial to improve the short-and long-term outcomes of patients.Some observational studies have shown that postoperative blood pressure increases,blood pressure variability,mean arterial pressure,and other blood pressure parameters are associated with patient outcomes.However,there are relatively few studies on intraoperative blood pressure and prognosis.This study mainly discusses the relationship between intraoperative blood pressure parameters and prognosis.At the same time,we can observe different collateral compensation and venous drainage in EVT through digital subtraction angiography(DSA),In many previous reports,different states of Pial collateral circulation(PCS)and venous drainage(VD)are closely related to the prognosis of patients.Collateral compensation and venous drainage were also included in the assessment of prognosis.The purpose of this study was to investigate the association between intraoperative blood pressure variability and prognosis,and some imaging data were included in the meta-analysis.ObjectiveTo investigate the relationship between intraoperative blood pressure variability and venous drainage and prognosis in patients with acute anterior circulation ischemic stroke who received endovascular treatment and successful recanalization.MethodsBy retrospective analysis in the first affiliated hospital of zhengzhou university nerve involvement in families and 2019-01-2020-02 caused by unilateral cycle before big vascular occlusion treated 92 patients with acute ischemic stroke were included in the cases of successful recanalization(mTICI level 2 b or higher),divided into two groups according to the 90 days after mRS score,collecting and statistics of mechanical bolt extraction for patients with blood pressure parameters:Average systolic blood pressure(Mean SBP),the highest systolic blood pressure(SBP)Max,lowest systolic blood pressure(Min SBP),define the variation coefficient,coefficients of variation(CV)=(SD/Mean)x 100(CV=(SD/Mean)x 100),systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse pressure(PP),Mean arterial pressure(MAP)the variation of parameters or CV SBP,CVDBP,CVPP,CVMAP,The collateral compensation and venous drainage were evaluated by intraoperative cerebral angiography.First,univariate analysis was used to analyze the factors that could affect the prognosis of patients,and then multivariate logistic regression was used to analyze the independent correlation between blood pressure parameters and other related factors and clinical prognosis.ResultsA total of 92 patients who met the inclusion criteria were included,with an average age of 62.1 ± 10.4 years old,including 50 males(54.3%),57 patients with hypertension(61.3%),24 patients with hyperlipidemia(26.1%),73 patients with diabetes(79.3%),and 29 patients with atrial fibrillation(31.5%).NIHSS score of 15.5±7.0 and ASPECT score of 5.96±1.86 at admission were both included.Mean SBP 135.0±21.4mmHg,maximum SBP 155.6±22.6mmHg,minimum SBP 108±10.1mmHg,coefficient of variation of systolic blood pressure(CV SBP)10.7±4.0,coefficient of variation of diastolic blood pressure(CVDBP)10.9±4.5,coefficient of variation of pulse pressure(CVPP)23.4±9.2,coefficient of variation of Mean arterial blood pressure(CVMAP)10.00±4.8,47 cases(51.1%)had poor prognosis(90-day MRS 3-6 points),45 cases(48.9%)had good prognosis(90-day MRS 0-2 points),and 24 cases(26.1%)had symptomatic bleeding transformation.43 cases of abnormal venous drainage(0-5 points),49 cases of good venous drainage(6-8 points),including 41 cases of early onset of veins,3 cases of delayed venous return,48 cases of normal venous return,38 cases of good pneumococcal collateral compensation(1-2 points),54 cases of poor pneumococcal collateral compensation(3-5 points)(58.1%).Patients’ baseline NIHSS score[OR 95%confidence interval 1.25(1.09-1.23),P<0.001],mean systolic blood pressure[OR 95%confidence interval 1.12(1.12-1.26),P<0.001],maximum systolic blood pressure[OR 95%confidence interval 1.09(1.02-1.38),P<0.005],Significant differences were found between the two groups in minimum systolic blood pressure[OR 95%confidence interval 1.25(1.17-1.63),P=0.003],variation parameters of pulse pressure[OR 95%confidence interval 1.45(1.13-1.96),P=0.006],pia collateral compensation[OR 95%confidence interval 0.39(1.16-1.53),P<0.001],and venous drainage[OR 95%confidence interval 0.63(1.57-0.86),P<0.001].Multi variate analysis showed that NIHSS score[OR 95%confidence interval 1.34(1.12-1.53),P=0.003],mean systolic blood pressure[OR 95%confidence interval 1.23(1.08-1.56),P=0.025],maximum systolic blood pressure[OR 95%confidence interval 1.21(1.25-1.83),P=0.033],minimum systolic blood pressure[OR 95%confidence interval 1.68(1.17-1.93),P=0.011],Variation parameters of pulse pressure[OR 95%confidence interval 1.87(1.33-2.06),P=0.028],pia collateral compensation[OR 95%confidence interval 0.59(1.31-1.93),P=0.013],and venous drainage[OR 95%confidence interval 0.81(1.17-1.63),P=0.005]were independent predictors of poor prognosis.NIHSS score on admission[OR 95%confidence interval 1.12(1.25-1.73),P=0.03],ASPECT score on admission[OR 95%confidence interval 0.74(1.67-1.95),P=0.01],and abnormal venous drainage[OR 95%confidence interval 0.73(1.13-1.51),P=0.01]were strongly associated with symptomatic intracranial hemorrhage.ConclusionsFor patients with acute anterior circulation occlusion of the great vessels of the ischemic stroke direct endovascular treatment and successful recanalization1.The decrease of intraoperative systolic blood pressure and the increase of variation coefficient of pulse pressure are closely related to the poor prognosis of patients2.Abnormal venous drainage and poor pia-meningeal collateral compensation are closely related to poor prognosis of patients3.Abnormal venous drainage is closely related to symptomatic intracranial hemorrhage... |
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