Τίτλος:
Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objective Permissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO. Methods Hourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24 hours following MT in consecutive nrLVO patients. Maximum, minimum, and mean BP levels were documented. Three-month functional independence (FI) was defined as modified Rankin Scale (mRS) scores of 0-2. Results A total of 88 nrLVO patients were evaluated post MT. Patients with FI had lower maximum SBP (160±19 mmHg vs 179±23 mmHg; P=0.001) and higher minimum SBP levels (119±12 mmHg vs 108±25 mmHg; P=0.008). Maximum SBP (183±20 mmHg vs 169±23 mmHg; P=0.008) and DBP levels (105±20 mmHg vs 89±18 mmHg; P=0.001) were higher in patients who died at 3 months while minimum SBP values were lower (102±28 mmHg vs 115±16 mmHg; P=0.007). On multivariable analyses, both maximum SBP (OR per 10 mmHg increase: 0.55, 95% CI 0.39 to 0.79; P=0.001) and minimum SBP (OR per 10 mmHg increase: 1.64, 95% CI 1.04 to 2.60; P=0.033) levels were independently associated with the odds of FI. Maximum DBP (OR per 10 mmHg increase: 1.61; 95% CI 1.10 to 2.36; P=0.014) and minimum SBP (OR per 10 mmHg increase: 0.65, 95% CI 0.47 to 0.90; P=0.009) values were independent predictors of 3-month mortality. Conclusions Our study demonstrates that wide BP excursions from the mean during the first 24 hours post MT are associated with worse outcomes in patients with nrLVO. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved.
Συγγραφείς:
Goyal, N.
Tsivgoulis, G.
Pandhi, A.
Dillard, K.
Alsbrook, D.
Chang, J.J.
Krishnaiah, B.
Nickele, C.
Hoit, D.
Alsherbini, K.
Alexandrov, A.V.
Arthur, A.S.
Elijovich, L.
Περιοδικό:
Journal of Neurointerventional Surgery
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
adult; Article; blood pressure; blood pressure measurement; blood pressure regulation; blood vessel occlusion; brain hemorrhage; clinical effectiveness; controlled study; diastolic blood pressure; female; Functional Independence Measure; human; major clinical study; male; mechanical thrombectomy; mortality; non recanalized large vessel occlusion; outcome assessment; patient safety; postoperative period; prediction; priority journal; Rankin scale; systolic blood pressure; aged; blood pressure; cerebrovascular disease; cohort analysis; hypertension; middle aged; pathophysiology; physiology; prospective study; retrospective study; thrombectomy; treatment outcome; trends, Adult; Aged; Blood Pressure; Cerebrovascular Disorders; Cohort Studies; Female; Humans; Hypertension; Male; Middle Aged; Prospective Studies; Retrospective Studies; Thrombectomy; Treatment Outcome
DOI:
10.1136/neurintsurg-2017-013581
