Abstract TMP88: Blood Pressure Variability Within 24 Hours After Recanalization Worsens Functional Outcome Among Patients Who Underwent Endovascular Treatment

• Published in: Stroke (1970) Vol. 51; no. Suppl_1
• Main Authors: Campos, Daniel, Requena, Manuel, Carvalho, Mariana, Saraiva, Marlene, Garcia-Tornel, Alvaro, Olive-Gadea, Marta, Rodriguez-Villatoro, Noelia, Juega, Jesus, Deck, Matias, Boned, Sandra, Muchada, Marian, Ballve, Alejandro, Llaurado, Arnau, Hernandez, David, Coscojuela, Pilar, Pagola, Jorge, Rodriguez-Luna, David, Tomasello, Alejandro, Ribo, Marc, Rubiera, Marta
• Format: Journal Article
• Language: English
• Published: 01.02.2020
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.51.suppl_1.TMP88

Abstract only Introduction: Systemic blood pressure (BP) should be strictly monitored and adjusted during the initial stages of stroke. Due to the impairment of cerebral autoregulation, cerebral blood flow is directly affected by systemic BP and some degree of permissive hypertension might be beneficial prior to reperfusion treatments to ensure an adequate perfusion in the ischemic tissue. However, after generalization of endovascular treatment (EVT) the rate of successful recanalization has skyrocketed and it is not well established if, once achieved, BP control should be stricter given its potential risks. We aim to explore the relation between BP and outcome among patients who underwent EVT. Methods: This is a retrospective study of a prospectively acquired unicentric database that includes patients who underwent EVT with successful recanalization measured by a mTICI ≥2b. Hourly measuring of systolic and diastolic BP was conducted during the first 24 hours post-procedure. BP variation was measured using standard deviation (SD) and range. We explored the effects of BP on functional outcome at 3 months and safety variables. Results: The study included 351 subjects with a mean age of 72.7+/-13.1 and 51.6% were men. The 3-months mRS was ≤2 in 50.4% of patients, 66 subjects (19.2%) presented hemorrhagic transformation and 67 (19.1%) were dead in the 3-months follow-up period. Both systolic BP SD (15.6+/-9.9 vs. 12.9+/-4.3; p<0.01) and range (55.6+/-18.4 vs. 48.7+/-16.4; p<0.01) were higher among patients with bad functional outcome (mRS>2). Subjects with hemorrhagic transformation presented higher range of DBP (35.7+/-12.4 vs. 32.0+/-11.9; p=0.03) and SBP (56.8+/-17.0 vs. 51.4+/-18.1; p=0.03) and higher diastolic DBP SD (9.3+/-4.1 vs. 8.2+/-2.7; p<0.01). In a logistic regression analysis DBP SD predicted ICH (OR 1.11, CI 1.02-1.22, p=0.01) and SBP range emerged as a predictor of poor functional outcome (OR 0.97, CI 0.96-0.99, p<0.01). No differences were detected in regard to admission BP, maximal and minimal BP or mean arterial pressure. Conclusions: Major fluctuations in systolic and diastolic BP predict increased risk of hemorrhagic complications and poor functional outcome. Minimizing BP fluctuations may improve outcome of EVT patients after recanalization.