Journal article
Temporal profiles of systolic blood pressure variability and neurologic outcomes after endovascular thrombectomy
European stroke journal, Vol.7(4), pp.365-375
12/2022
DOI: 10.1177/23969873221106907
PMCID: PMC9720854
PMID: 36478756
Abstract
Introduction: Observational studies have found an increased risk of hemorrhagic transformation and worse functional outcomes in patients with higher systolic blood pressure variability (BPV). However, the time-varying behavior of BPV after endovascular thrombectomy (EVT) and its effects on functional outcome have not been well characterized. Patients and methods: We analyzed data from an international cohort of patients with large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 h after thrombectomy. Parameters of BPV were calculated in 12-h epochs using five established methodologies. Systolic BPV trajectories were generated using group-based trajectory modeling, which separates heterogeneous longitudinal data into groups with similar patterns. Results: Of the 2041 patients (age 69 ± 14, 51.4% male, NIHSS 15 ± 7, mean number of BP measurements 50 ± 28) included in our analysis, 1293 (63.4%) had a poor 90-day outcome (mRS ⩾ 3) or a poor discharge outcome (mRS ⩾ 3). We identified three distinct SBP trajectories: low (25%), moderate (64%), and high (11%). Compared to patients with low BPV, those in the highest trajectory group had a significantly greater risk of a poor functional outcome after adjusting for relevant confounders (OR 2.2; 95% CI 1.2–3.9; p = 0.008). In addition, patients with poor outcomes had significantly higher systolic BPV during the epochs that define the first 24 h after EVT ( p < 0.001). Discussion and conclusions: Acute ischemic stroke patients demonstrate three unique systolic BPV trajectories that differ in their association with functional outcome. Further research is needed to rapidly identify individuals with high-risk BPV trajectories and to develop treatment strategies for targeting high BPV.
Details
- Title: Subtitle
- Temporal profiles of systolic blood pressure variability and neurologic outcomes after endovascular thrombectomy
- Creators
- Ayush Prasad - Yale UniversityJessica Kobsa - Yale UniversitySreeja Kodali - Yale UniversityDavid Bartolome - Yale UniversityLiza Begunova - Yale UniversityDarko Quispe-Orozco - University of IowaMudassir Farooqui - University of IowaCynthia Zevallos - University of IowaSantiago Ortega-Gutiérrez - University of IowaMohammad Anadani - Medical University of South CarolinaEyad Almallouhi - Medical University of South CarolinaAlejandro M Spiotta - Medical University of South CarolinaJames A Giles - Washington University in St. LouisSalah G Keyrouz - Washington University in St. LouisJoon-Tae Kim - Department of Neurology, Chonnam National University Medical School, Gwangju, South KoreaIlko L Maier - University of GöttingenJan Liman - University of GöttingenMarios-Nikos Psychogios - University Hospital of BaselNolwenn Riou-Comte - Centre Hospitalier Universitaire de NancySébastien Richard - Centre Hospitalier Universitaire de NancyBenjamin Gory - Centre Hospitalier Universitaire de NancyStacey Quintero Wolfe - Departments of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USAPatrick A Brown - Wake Forest UniversityKyle M Fargen - Wake Forest UniversityEva A Mistry - University of CincinnatiHiba Fakhri - Vanderbilt University Medical CenterAkshitkumar Mistry - University of LouisvilleKa-Ho Wong - University of UtahFábio A Nascimento - Baylor College of MedicinePeter Kan - Baylor College of MedicineAdam de Havenon - Yale UniversityKevin N Sheth - Yale UniversityNils H Petersen - Yale University
- Resource Type
- Journal article
- Publication Details
- European stroke journal, Vol.7(4), pp.365-375
- DOI
- 10.1177/23969873221106907
- PMID
- 36478756
- PMCID
- PMC9720854
- NLM abbreviation
- Eur Stroke J
- ISSN
- 2396-9873
- eISSN
- 2396-9881
- Grant note
- DOI: 10.13039/100000065, name: National Institute of Neurological Disorders and Stroke, award: K23NS110980
- Language
- English
- Electronic publication date
- 06/24/2022
- Date published
- 12/2022
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984303025802771
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