Journal article
Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study
Stroke (1970), Vol.53(4), pp.1216-1225
04/2022
DOI: 10.1161/STROKEAHA.121.034408
PMCID: PMC8960326
PMID: 34781705
Abstract
Elevated blood pressure after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and poor functional outcomes. However, the optimal hemodynamic management after EVT remains unknown, and the blood pressure course in the acute phase of ischemic stroke has not been well characterized. This study aimed to identify patient subgroups with distinct blood pressure trajectories after EVT and study their association with radiographic and functional outcomes.
This multicenter retrospective cohort study included consecutive patients with anterior circulation large-vessel occlusion ischemic stroke who underwent EVT. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Latent variable mixture modeling was used to separate subjects into five groups with distinct postprocedural systolic blood pressure (SBP) trajectories. The primary outcome was functional status, measured on the modified Rankin Scale 90 days after stroke. Secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and death.
Two thousand two hundred sixty-eight patients (mean age [±SD] 69±15, mean National Institutes of Health Stroke Scale 15±7) were included in the analysis. Five distinct SBP trajectories were observed: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%). SBP trajectory group was independently associated with functional outcome at 90 days (
<0.0001) after adjusting for potential confounders. Patients with high and high-to-moderate SBP trajectories had significantly greater odds of an unfavorable outcome (adjusted odds ratio, 3.5 [95% CI, 1.8-6.7],
=0.0003 and adjusted odds ratio, 2.2 [95% CI, 1.5-3.2],
<0.0001, respectively). Subjects in the high-to-moderate group had an increased risk of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.82 [95% CI, 1-3.2];
=0.04). No significant association was found between trajectory group and hemorrhagic transformation.
Patients with acute ischemic stroke demonstrate distinct SBP trajectories during the first 72 hours after EVT that have differing associations with functional outcome. These findings may help identify potential candidates for future blood pressure modulation trials.
Details
- Title: Subtitle
- Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study
- Creators
- Nils H Petersen - Yale UniversitySreeja Kodali - Yale UniversityCan Meng - Yale UniversityFangyong Li - AnalyticaCindy Khanh Nguyen - Yale UniversityKrithika U Peshwe - Yale UniversitySumita Strander - Yale UniversityAndrew Silverman - Yale UniversityAlexandra Kimmel - Yale UniversityAnson Wang - Yale UniversityMohammad Anadani - Medical University of South CarolinaEyad Almallouhi - Medical University of South CarolinaAlejandro M Spiotta - Medical University of South CarolinaJoon-Tae Kim - Chonnam National UniversityJames A Giles - Washington University in St. LouisSalah G Keyrouz - Washington University in St. LouisMudassir Farooqui - University of IowaCynthia Zevallos - University of IowaIlko L Maier - University of GöttingenMarios-Nikos Psychogios - University Hospital of BaselJan Liman - University of GöttingenNolwenn Riou-Comte - Department of Neurology, University Hospital of Nancy, France. (N.R.-C., S.R.)Sébastien Richard - Nancy-UniversitéBenjamin Gory - University of LorraineStacey Quintero Wolfe - Department of Radiology (P.A.B), Wake Forest School of Medicine, Winston-Salem, NCPatrick A Brown - Wake Forest UniversityKyle M Fargen - Wake Forest UniversityEva A Mistry - Vanderbilt University Medical CenterHiba Fakhri - Vanderbilt University Medical CenterAkshitkumar M Mistry - Vanderbilt University Medical CenterKa-Ho Wong - University of UtahAdam de Havenon - University of UtahFábio A Nascimento - Baylor College of MedicinePeter Kan - Baylor College of MedicineCharles Matouk - Yale UniversitySantiago Ortega-Gutiérrez - University of IowaKevin N Sheth - Yale University
- Resource Type
- Journal article
- Publication Details
- Stroke (1970), Vol.53(4), pp.1216-1225
- DOI
- 10.1161/STROKEAHA.121.034408
- PMID
- 34781705
- PMCID
- PMC8960326
- NLM abbreviation
- Stroke
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Grant note
- K23 NS110980 / NINDS NIH HHS R01 NR018335 / NINR NIH HHS U01 NS106513 / NINDS NIH HHS U24 NS107136 / NINDS NIH HHS U24 NS107215 / NINDS NIH HHS
- Language
- English
- Date published
- 04/2022
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984302206602771
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