| Objective:To investigate the effect of blood pressure on the prognosis of patients with acute anterior circulation ischemic stroke with occlusive large vessels.To provide basis for clinicians in blood pressure management of these patients,to reduce the mortality rate,disability rate and reduce the family and social burden of these patients.Methods:The clinical data of patients with acute ischemic stroke with occlusive large vessels from December 2016 to March 2021 in The Affiliated Hospital of Guizhou Medical University were retrospectively analyzed.Patients’ age,gender,underlying disease,NIHSS score at onset and Modified Rankin were included Scale(m RS)score,imaging data,responsible vessels,treatment method(mechanical thrombectomy,thrombolysis),vascular recanalization,systolic blood pressure and diastolic blood pressure within 24 hours after mechanical thrombectomy or 24 hours after admission if no mechanical thrombectomy,postoperative NIHSS score,m RS score,m RS score90 days after mechanical thrombectomy were recorded,etc.All patients were divided into two groups according to m RS score at 90 days and postoperative head CT: m RS0-2 vs m RS 3-6(representing functional independent group and non-functional independent group respectively);Death group and non-death group,cerebral hemorrhage group and non-cerebral hemorrhage group,cerebral hernia group and non-cerebral hernia group.All data were analyzed by SPSS V.25.0software.Continuous variables conforming to normal distribution are represented by(P<0.05).The independent sample T test was used for comparison between groups.The measurement data that did not conform to normal distribution were represented by median and quartile spacing,and rank sum test was used for comparison between the two groups.The data of categorical variables were represented by the number of cases and percentage,and the chi-square test was used for comparison between groups.Logistic regression model was used to analyze the relationship between maximum systolic blood pressure,mean systolic blood pressure,minimum systolic blood pressure,maximum diastolic blood pressure,mean diastolic blood pressure,minimum diastolic blood pressure at the first 24 hours after mechanical thrombolectomy and functional prognosis at 90 days,as well as its relationship with complications.Odds ratios(OR)and 95% confidence intervals(CI)were calculated to determine any association,P<0.05 is significant difference.The independent factors found in the regression analysis were used to find the optimal blood pressure value to distinguish the clinical outcome with Receiver Operating Characteristics curve.Results:A total of 445 patients with acute ischemic stroke were found in the Affiliated Hospital of Guizhou Medical University,among which 193 patients met the inclusion and exclusion criteria in the first part.The specific results were as follows: the mean age of patients was 63.88±12.57 years old,112(58.03%)were male,81(41.97%)were female.The location of large vessel occlusion was :65 cases were located in internal carotid artery(ICA;33.68%).The M1 segment of middle cerebral artery was94 cases(48.70%)and M2 segment was 23 cases(11.92%).The remaining 11 patients had tandem occlusion(5.70%).The median time from onset to groin was69.00 min in 193 patients,of whom 140(72.54%)reached vascular recanalization m TICI3 and 2B.The mean systolic blood pressure on admission was141.30±23.61 mm Hg.The incidence of postoperative cerebral hemorrhage was 30(15.54%).A total of 71 patients(36.79%)had obvious neurological dysfunction after 90 days of follow-up,and 54 patients(27.98%)died 90 days after mechanical thrombectomy.The maximum systolic blood pressure,maximum diastolic blood pressure and vascular recanalization were statistically significant in the comparison between the two groups with independent function(P<0.05).The incidence of atrial fibrillation was statistically significant in cerebral hemorrhage(P<0.05).The maximum systolic blood pressure was statistically significant between the two groups with or without cerebral hernia(P< 0.05).The maximum systolic blood pressure and diastolic blood pressure were statistically significant between the two groups after death(P< 0.05).Results of regression analysis of blood pressure and function independence at 90 days showed that maximum systolic blood pressure was associated with patient function independence(P<0.05).Logistic regression analysis showed that intracerebral hemorrhage was independently associated with 90-day function(P<0.05).Logistic regression analysis of blood pressure and risk of death showed that maximum systolic blood pressure,maximum diastolic blood pressure and independent risk factors of death(P< 0.05).The results showed that diabetes mellitus and cerebral hernia were independent risk factors for death(P< 0.05).The patient Yoden index was calculated by ROC curve.Statistical results showed that the optimal maximum systolic blood pressure watershed for functional independence at 90 days was 166.5mm Hg(sensitivity: 0.882,specificity: 0.52,area under curve: 0.714).The optimal watershed for death was 173.5mm Hg(sensitivity: 0.796,specificity: 0.885,area under curve: 0.850)and 98.5mm Hg(sensitivity: 0.778,specificity: 0.655,area under curve: 0.785).2.A total of 70 patients met the inclusion and exclusion criteria in Part two of this study.The mean age was 61.83±15.24 years,with 39(55.71%)male and 31(44.29%)female.The location of large vessel occlusion was :55 cases were located in intracranial internal carotid artery(ICA;35.71%).There were 29 cases(41.43%)in M1 segment and 12 cases(17.14%)in M2 segment of middle cerebral artery.The remaining 4 patients had tandem occlusion(5.71%).The systolic blood pressure on admission was 157.46±26.62 mm Hg,and the diastolic blood pressure on admission was 96.73±16.37 mm Hg.A total of 15 patients were functionally independent after 90 days of follow-up,34 patients had significant neurological dysfunction,and 21 patients died 90 days after onset.Functional independent inter-group comparison showed that hypertension,hyperlipidemia,maximum systolic blood pressure,mean systolic blood pressure,NIHSS score at admission were statistically significant between the two groups(P < 0.05).The results showed that NIHSS score,systolic blood pressure,mean systolic blood pressure,maximum systolic blood pressure and diastolic blood pressure at admission were statistically significant between the two groups(P < 0.05).Logistic regression was used to further study the relationship between blood pressure and functional independence and mortality.Univariate regression analysis showed that maximum systolic blood pressure and mean systolic blood pressure were significantly correlated with functional independence after 90days(P< 0.05).However,multivariate regression analysis showed that the maximum systolic blood pressure and mean systolic blood pressure had no statistical significance(P< 0.05).Univariate regression analysis showed that mean systolic blood pressure,maximum systolic blood pressure,maximum diastolic blood pressure and the risk of death were statistically significant(P< 0.05).Multivariate regression analysis showed that the maximum systolic blood pressure was statistically significant(P< 0.05).This suggests that maximal systolic blood pressure is an independent risk factor for death.Therefore,the maximum systolic blood pressure watershed for understanding the risk of death by ROC curve was 180.5mm Hg(sensitivity: 0.765,specificity: 0.83,area under curve: 0.792).Conclusions:1.Whether recanalized or not,lowering blood pressure within 24 hours post mechanical thrombectomy may have a positive effect on the clinical prognosis of patients with acute anterior circulation large vessel occlusion ischemic stroke.2.The90-day functional independence and mortality of patients who underwent mechanical thrombectomy were independently correlated with the maximum systolic blood pressure,which was 166.5mm Hg could be used as the best judgment value to distinguish patients’ functional independence.The optimal threshold for maximum systolic blood pressure affecting mortality was 173.5mm Hg.3.Without recanalization therapy,the 90-day mortality of patients without recanalization was independently correlated with the maximum systolic blood pressure,and when the maximum systolic blood pressure was greater than 180.5mm Hg,the risk of death was increased. |
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