Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment
Background and purposeAn aggressive lowering of blood pressure (BP) could lead to neurological worsening, particularly of the area that has not been reperfused in acute stroke patients with large vessel occlusion (LVO). We sought to investigate the association of reperfusion status and BP course fol...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-11-01
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| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2023.1238653/full |
| _version_ | 1797629412735188992 |
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| author | Hongye Xu Hongye Xu He Li He Li Ping Zhang Yuan Gao Hanchen Liu Hongjian Shen Weilong Hua Lei Zhang Zifu Li Yongxin Zhang Pengfei Xing Xiaoxi Zhang Pengfei Yang Jianmin Liu |
| author_facet | Hongye Xu Hongye Xu He Li He Li Ping Zhang Yuan Gao Hanchen Liu Hongjian Shen Weilong Hua Lei Zhang Zifu Li Yongxin Zhang Pengfei Xing Xiaoxi Zhang Pengfei Yang Jianmin Liu |
| author_sort | Hongye Xu |
| collection | DOAJ |
| description | Background and purposeAn aggressive lowering of blood pressure (BP) could lead to neurological worsening, particularly of the area that has not been reperfused in acute stroke patients with large vessel occlusion (LVO). We sought to investigate the association of reperfusion status and BP course following mechanical thrombectomy (MT) with outcomes in LVO.Materials and methodsConsecutive patients with LVO treated with MT between Jan 2020 to Jun 2021 were enrolled in a retrospective cohort study. Hourly systolic BP (SBP) and diastolic BP (DBP) were recorded for 72 h following MT and maximum SBP and DBP levels were identified. The Extended Thrombolysis in Cerebral Infarction (eTICI) scale was used to assess reperfusion extent. LVO patients were stratified in 2 groups based on reperfusion status: complete reperfusion (eTICI 3) and incomplete reperfusion (eTICI 2b/c). Three-month functional independence was defined as a modified Rankin Scale score of 0–2.ResultsA total of 263 acute ischemic stroke patients with LVO were retrospectively evaluated. Complete reperfusion was achieved in 210 patients (79.8%). Post-MT maximum SBP over 160 mmHg was significantly related to worse functional outcome (38.1% vs. 55.7%, p = 0.006), higher likelihood of in-hospital mortality and 3-month mortality (19.0% vs. 6.9%, p = 0.004, 27.4% vs. 14.3%, p = 0.012). No statistical correlation was found between reperfusion status and blood pressure level (p > 0.05). In patients with complete reperfusion, patients with an average BP 120-140 mmHg tends to have worse functional outcome compared with 100-120 mmHg (OR = 1.77, 95%CI: 0.97–3.23, p = 0.061).ConclusionHigh maximum SBP levels following MT are associated with an increased likelihood of 3-month functional dependence and mortality. An average BP of 100–120 mmHg tends to have better functional independence in completely reperfused patients. The effect of intensive BP control on incomplete reperfusion still warrants further investigations. |
| first_indexed | 2024-03-11T10:53:57Z |
| format | Article |
| id | doaj.art-410456af1e784ade89ae5b92ff84eae8 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-11T10:53:57Z |
| publishDate | 2023-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-410456af1e784ade89ae5b92ff84eae82023-11-13T11:57:18ZengFrontiers Media S.A.Frontiers in Neurology1664-22952023-11-011410.3389/fneur.2023.12386531238653Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatmentHongye Xu0Hongye Xu1He Li2He Li3Ping Zhang4Yuan Gao5Hanchen Liu6Hongjian Shen7Weilong Hua8Lei Zhang9Zifu Li10Yongxin Zhang11Pengfei Xing12Xiaoxi Zhang13Pengfei Yang14Jianmin Liu15Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNo. 904 Hospital of the PLA Joint Logistics Support Force, Wuxi, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaDepartment of Emergency, Naval Medical Center of PLA, Naval Medical University, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaNeurovascular Center, Naval Medical University Changhai Hospital, Shanghai, ChinaBackground and purposeAn aggressive lowering of blood pressure (BP) could lead to neurological worsening, particularly of the area that has not been reperfused in acute stroke patients with large vessel occlusion (LVO). We sought to investigate the association of reperfusion status and BP course following mechanical thrombectomy (MT) with outcomes in LVO.Materials and methodsConsecutive patients with LVO treated with MT between Jan 2020 to Jun 2021 were enrolled in a retrospective cohort study. Hourly systolic BP (SBP) and diastolic BP (DBP) were recorded for 72 h following MT and maximum SBP and DBP levels were identified. The Extended Thrombolysis in Cerebral Infarction (eTICI) scale was used to assess reperfusion extent. LVO patients were stratified in 2 groups based on reperfusion status: complete reperfusion (eTICI 3) and incomplete reperfusion (eTICI 2b/c). Three-month functional independence was defined as a modified Rankin Scale score of 0–2.ResultsA total of 263 acute ischemic stroke patients with LVO were retrospectively evaluated. Complete reperfusion was achieved in 210 patients (79.8%). Post-MT maximum SBP over 160 mmHg was significantly related to worse functional outcome (38.1% vs. 55.7%, p = 0.006), higher likelihood of in-hospital mortality and 3-month mortality (19.0% vs. 6.9%, p = 0.004, 27.4% vs. 14.3%, p = 0.012). No statistical correlation was found between reperfusion status and blood pressure level (p > 0.05). In patients with complete reperfusion, patients with an average BP 120-140 mmHg tends to have worse functional outcome compared with 100-120 mmHg (OR = 1.77, 95%CI: 0.97–3.23, p = 0.061).ConclusionHigh maximum SBP levels following MT are associated with an increased likelihood of 3-month functional dependence and mortality. An average BP of 100–120 mmHg tends to have better functional independence in completely reperfused patients. The effect of intensive BP control on incomplete reperfusion still warrants further investigations.https://www.frontiersin.org/articles/10.3389/fneur.2023.1238653/fullreperfusion statuspostoperative blood pressurestrokeendovascular treatmenteTICI |
| spellingShingle | Hongye Xu Hongye Xu He Li He Li Ping Zhang Yuan Gao Hanchen Liu Hongjian Shen Weilong Hua Lei Zhang Zifu Li Yongxin Zhang Pengfei Xing Xiaoxi Zhang Pengfei Yang Jianmin Liu Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment Frontiers in Neurology reperfusion status postoperative blood pressure stroke endovascular treatment eTICI |
| title | Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment |
| title_full | Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment |
| title_fullStr | Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment |
| title_full_unstemmed | Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment |
| title_short | Reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment |
| title_sort | reperfusion status and postoperative blood pressure in acute stroke patients after endovascular treatment |
| topic | reperfusion status postoperative blood pressure stroke endovascular treatment eTICI |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2023.1238653/full |
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