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Prolonged Heightened Blood Pressure Following Mechanical Thrombectomy for Acute Stroke is Associated with Worse Outcomes

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Abstract

Background

Most data evaluating the relationship of post-mechanical thrombectomy (MT) blood pressure (BP) management and outcomes of patients with large vessel occlusion (LVO) focus on early BP control within the first 24 h. We investigated the correlation of daily BP trends up to the third day following MT with patient outcomes.

Methods

We retrospectively reviewed our prospectively maintained database for LVO patients treated with MT from February 2015 to December 2017. Recorded BP values for 72 h post-reperfusion were reviewed. Daily peak systolic and diastolic blood pressures (SBP, DBP) were extracted for each day post-procedure. The association and importance between BP increments of 10 mmHg and mortality, hemorrhage, and functional independence (FI = mRS ≤ 2) was analyzed in a multivariable logistic regression and random forest (RF) analyses modeling.

Results

A total of 212 thrombectomies were included. An increase in peak 24-h SBP was independently associated with higher likelihood of symptomatic hemorrhage (OR 1.2, p = 0.048) and decreased functional independence (OR 0.85, p = 0.03). Higher day 2 and day 3 peak SBP was strongly correlated with decreased functional independence and higher mortality. Third day SBP < 140 was independently associated with higher likelihood of functional independence (OR 4.3, p = 0.0004). Post-MT patients with and without functional independence demonstrated a similar relative decrease in peak SBP between the first 2 days following thrombectomy (p = 0.26); however, those without functional independence experienced a significant rebound increase in peak SBP on the third day following MT (mean change from day 2 to 3: FI − 3.5 mmHg, non-FI + 3.9 mmHg; p = 0.005).

Conclusion

High daily maximum SBP and a rebound SBP on the third day following MT is independently associated with increased likelihood of functional dependence.

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Funding

Study was unfunded.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Miami, Miami, USA

    David J. McCarthy, Evan Luther, Dallas Sheinberg, Jean-Paul Bryant, Omar Elwardany, John Kimball & Robert M. Starke

  2. Department of Neurology, University of Miami, Miami, USA

    Maranatha Ayodele

  3. University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, 2nd Floor (D4-6), Miami, FL, 33136, USA

    David J. McCarthy

Authors
  1. David J. McCarthy
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  2. Maranatha Ayodele
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  3. Evan Luther
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  4. Dallas Sheinberg
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  5. Jean-Paul Bryant
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  6. Omar Elwardany
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  7. John Kimball
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  8. Robert M. Starke
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Contributions

DMC and RMS were involved in conception and design, acquisition, analysis, interpretation of data, drafting the article, final approval. MA and EL contributed to conception and design, revising article for important intellectual content, final approval. DS, JPB, OE, and JK were involved in conception and design, analysis, interpretation of data, revising article for important intellectual content, final approval.

Corresponding author

Correspondence to David J. McCarthy.

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No authors have any relevant conflicts to disclose.

Ethical approval

All studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Approval for this study was granted by the local ethics committee.

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Informed consent was obtained from all individual participants included in the study according to local regulations.

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The data will be made available upon request to the corresponding author.

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McCarthy, D.J., Ayodele, M., Luther, E. et al. Prolonged Heightened Blood Pressure Following Mechanical Thrombectomy for Acute Stroke is Associated with Worse Outcomes. Neurocrit Care 32, 198–205 (2020). https://doi.org/10.1007/s12028-019-00803-7

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  • DOI: https://doi.org/10.1007/s12028-019-00803-7

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