Resident SUNY Upstate Syracuse, New York, United States
Disclosure(s):
Haydn Hoffman, MD: No financial relationships to disclose
Introduction: Limited data exists regarding the effect of pre-reperfusion blood pressure on outcomes following mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (ACLVO).
Methods: All patients who underwent MT for ACLVO between 2015 – 2021 at a single institution were reviewed. Independent variables included systolic blood pressure (SBP) and mean arterial pressure (MAP) measurements obtained on presentation and between presentation and reperfusion (pre-reperfusion). Mean, minimum, maximum, and standard deviations were calculated for pre-reperfusion measurements. Outcomes included favorable functional status (modified Rankin Scale [mRS] 0 – 2) at 90 days and post-procedural intracranial hemorrhage (ICH). Multivariate logistic regression analyses adjusting for age, premorbid mRS, admission NIHSS, ASPECTS, collateral score, tPA administration, onset to reperfusion time, and TICI grade were performed. Youden’s index was calculated to identify SBP and MAP thresholds for each outcome.
Results: A total of 394 patients (196 males, 198 females) with a mean age (SD) of 70.9 years (15.2) were included. Admission SBP and MAP values were not associated with 90-day favorable mRS or ICH. Higher pre-reperfusion maximum SBP (OR 0.72, 95% CI 0.55 – 0.93), standard deviation of SBP (OR 0.77, 95% CI 0.59 – 0.98), and standard deviation of MAP (OR 0.64, 95% CI 0.44 – 0.89) were associated with lower odds of 90-day favorable mRS. Higher maximum SBP (OR 1.37, 95% CI 1.08 - 1.73), maximum MAP (OR 1.32, 95% CI 1.05 - 1.66), standard deviation of SBP (OR 1.27, 95% CI 1.01 - 1.60), and standard deviation of MAP (1.48, 95% CI 1.11 - 2.08) were associated with greater odds of ICH. Optimal maximum SBP and MAP cutoffs for predicting ICH were 172 and 128 mmHg, respectively.
Conclusion : Higher peak and variability in SBP and MAP during the pre-reperfusion period are associated with unfavorable functional status and ICH after MT for ACLVO.
