Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke
An Individual Patient Data Meta-analysis
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Abstract
Background and Objectives To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of patients with acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).
Methods A study was eligible if it enrolled patients with AIS >18 years of age with an LVO treated with either successful or unsuccessful EVT and provided either individual or mean 24-hour systolic BP values after the end of the EVT procedure. Individual patient data from all studies were analyzed with a generalized linear mixed-effects model.
Results A total of 5,874 patients (mean age 69 ± 14 years; 50% women; median NIH Stroke Scale score on admission 16) from 7 published studies were included. Increasing mean systolic BP levels per 10 mm Hg during the first 24 hours after the end of the EVT were associated with a lower odds of functional improvement (unadjusted common odds ratio [OR] 0.82, 95% confidence interval [CI] 0.80–0.85; adjusted common OR 0.88, 95% CI 0.84–0.93) and modified Rankin Scale score ≤2 (unadjusted OR 0.82, 95% CI 0.79–0.85; adjusted OR 0.87, 95% CI 0.82–0.93) and a higher odds of all-cause mortality (unadjusted OR 1.18, 95% CI 1.13–1.24; adjusted OR 1.15, 95% CI 1.06–1.23) at 3 months. Higher 24-hour mean systolic BP levels were also associated with an increased likelihood of early neurologic deterioration (unadjusted OR 1.14, 95% CI 1.07–1.21; adjusted OR 1.14, 95% CI 1.03–1.24) and a higher odds of symptomatic intracranial hemorrhage (unadjusted OR 1.20, 95% CI 1.09–1.29; adjusted OR 1.20, 95% CI 1.03–1.38) after EVT.
Discussion Increased mean systolic BP levels in the first 24 hours after EVT are independently associated with a higher odds of symptomatic intracranial hemorrhage, early neurologic deterioration, 3-month mortality, and worse 3-month functional outcomes.
Glossary
- AIS=
- acute ischemic stroke;
- BP=
- blood pressure;
- BP-TARGET=
- Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy;
- CI=
- confidence interval;
- ENHANCED=
- Enhanced Control of Hypertension and Thrombolysis Stroke Study;
- EVT=
- endovascular thrombectomy;
- ICH=
- intracranial hemorrhage;
- IPD-MA=
- individual patient data meta-analysis;
- mRS=
- modified Rankin Scale;
- NIHSS=
- NIH Stroke Scale;
- OR=
- odds ratio;
- SITS=
- Safe Implementation of Thrombolysis in Stroke;
- tPA=
- tissue plasminogen activator
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received May 12, 2021.
- Accepted in final form October 29, 2021.
- © 2021 American Academy of Neurology
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Disputes & Debates: Rapid online correspondence
- Reader Response: Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis
- Rwoof Reshi, Physician, University of Oklahoma
Submitted March 13, 2022
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