Impact Of Blood Pressure Levels Within First 24 Hours After Mechanical Thrombectomy For Acute Anterior Vessel Occlusion On Clinical Outcome In Acute Ischemic Stroke Patients

ObjectiveEndovascular therapy is the best treatment method for ischemic stroke caused by acute large vessel occlusion.By 2021,the success rate of endovascular recanalization has been improved to 70-80%.However,despite successful mechanical thrombectomy,nearly half of the patients still have poor prognosis（m RS Score>2 at 90 days）.Acute phase hypertension has been shown to be an independent factor for poor outcomes in 80%of AIS patients.Perioperative blood pressure regulation has a certain effect on the prognosis of patients with acute great vascular occlusive ischemic stroke after mechanical thrombectomy.In this study,we analyzed the blood pressure level at 24 hours after endovascular therapy and the clinical outcome at 90 days,aiming to further explore the association between blood pressure and reperfusion and functional outcome during perioperative period of endovascular therapy,and to provide a certain reference for the blood pressure regulation level in 24 hours after endovascular therapy.MethodsFrom January 2021 to August 2022,acute ischemic stroke patients admitted to the Second Department of Neurology,China-Japan Friendship Hospital of Jilin University were selected as subjects.The systolic blood pressure,diastolic blood pressure and baseline data of the above patients 24 hours after surgery were collected.24 patients with an average systolic blood pressure<120mm Hg were set as the experimental group,and 76 patients with an average systolic blood pressure of120-140mm Hg were set as the control group.The patients were followed up for 3months.Changes in the National Institute of Health stroke scale（NIHSS）score at 24hours after thrombolysis and m RS Scores at 90 days were assessed and registered.The relationship between blood pressure 24 hours after endovascular therapy and early neurological function and clinical prognosis was analyzed.Mean systolic blood pressure（SBP）,mean diastolic blood pressure（DBP）,mean pulse pressure（PP=SBP-DBP）,mean arterial pressure[MAP=（SBP+2×DBP）÷3],blood pressure variability（blood pressure variability,BPV）,define coefficients of variation（CV）as（Standard deviation/MEAN）×100[CV=（SD/MEAN）×100],The coefficients of variation of mean systolic blood pressure,mean diastolic blood pressure,mean pulse pressure and mean arterial pressure,namely CV_SBP,CV_DBP,CV_PPand CV_MAP,were obtained.The relationship between blood pressure variation rate and 90-day clinical prognosis and compensation was analyzed,and the prognostic model was established according to blood pressure and clinical baseline data.ResultsThe 90-day clinical prognosis（m RS Score）of the group with blood pressure control at 24 h after operation was better than that of the<120mm Hg group（OR=0.241,95%confidence interval=0.092-0.629）.The coefficient of variance of pulse pressure(CV_PP)may be different between the good prognosis group and the poor prognosis group（P=0.05）,while the difference of CV_SBP,CV_MAPand CV_DBPwas not statistically significant between the good prognosis group and the poor prognosis group（P>0.05）.Logistic regression model and ORs were used to calculate the correlation between baseline factors and 90-day m RS.Univariate analysis and Logistic multivariate analysis showed that diabetes,early neurological deterioration and blood pressure group were closely correlated with poor prognosis（P<0.05）.ConclusionThe 90-day clinical prognosis（m RS Score）of the group with blood pressure of120-140mm Hg 24 hours after intravascular therapy is better than that of the<120mm Hg group.Therefore,in patients with acute ischemic stroke receiving intravascular therapy,the blood pressure lowering level should follow the principle of individuation.Intensive blood pressure lowering cannot significantly improve the prognosis of patients.In addition,monitoring the changes of nervous system function 24 hours after endovascular therapy is conducive to timely taking relevant measures to improve the prognosis of patients.