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Abstract WP11: Timing of Blood Pressure Decreases During Mechanical Thrombectomy for Ischemic Stroke
Abstract   Peer reviewed

Abstract WP11: Timing of Blood Pressure Decreases During Mechanical Thrombectomy for Ischemic Stroke

Alexandra C Kimmel, Andrew Silverman, Sreeja Kodali, Sumita Strander, Cindy Khanh Nguyen, Krithika Umesh Peshwe, Anson Wang, Gloria V Lopez, Andrea Holcombe, Cynthia Zevallos, …
Stroke (1970), Vol.51(Suppl_1)
02/2020
DOI: 10.1161/str.51.suppl_1.WP11

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Abstract

Introduction: Decreases in blood pressure (BP) during endovascular therapy (EVT) are associated with infarct progression and poor outcome. The largest BP reductions are thought to occur during induction. The frequency and clinical relevance of late BP decreases after partial reperfusion has been achieved remain unknown. In this study, we aimed to characterize the timing of BP reductions during EVT and to assess their association with functional outcome. Methods: We retrospectively studied patients with LVO stroke who underwent EVT at two comprehensive stroke centers. BP was continuously monitored throughout the procedure and averaged for selected time points. Maximum BP drop was calculated as the difference between admission systolic BP (SBP) and lowest SBP during EVT and assigned to one of three intervals: 1) arrival to angiography suite to groin puncture, 2) groin puncture to first pass, and 3) first pass to recanalization. Functional outcome was assessed using the modified rankin scale (mRS) at 90 days. Associations with the outcome were analyzed using ordinal logistic regression and adjusted for the size of the maximum drop in SBP. Results: 401 patients (age 71.3±14, 57% female, mean NIHSS 17) were included. Mean SBP for all patients decreased from EVT start to first procedural angiogram and then stabilized (Figure 1A). While the majority of blood pressure reductions occurred during interval 1 and 2 (n=253, 70%), 30% took place after first pass. We found no relation between timing of BP reduction and outcome (p=0.780, Figure 1B). Decreases in SBP during all intervals were significantly associated with 90-day outcome (OR per 10 mmHg 1.2, p=0.013; OR 1.1, p=0.025; and OR 1.3, p=0.011 for interval 1-3, respectively). Conclusions: BP drops occur throughout EVT, including between first pass and recanalization. Regardless of when these drops occur, they associate with poor outcome and thus underline the importance of blood pressure management throughout the procedure.

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