Background & Purpose: High pre-treatment systolic blood pressure (SBP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for acute ischemic stroke (AIS) patients with emergent large vessel occlusion (ELVO). We sought to evaluate the association of of pre-treatment SBP with other outcome measures after EVT including final infarct volume (FIV) and favorable outcome (FO) at three-months.
Methods: We conducted a retrospective cohort study evaluating AIS patients presenting with anterior circulation ELVO in a tertiary care stroke center during a 4-year period. Admission stroke severity was documented using NIHSS-score. Pre-treatment SBP and DBP were measured using automated cuff. Two investigators calculated the FIV using ABC/2 methodology. FO was defined as mRS score of 0-2 at 3 months.
Results: Our study population consisted of 116 patients with anterior circulation ELVO (mean age 63±13 years, 51% male, median admission NIHSS-score: 17 points, IQR 14-21, median FIV: 30cm3, IQR: 8-94) who were treated with EVT. Systemic thrombolysis was administered in 75 patients (65%). A total of 38 patients (33%) achieved FO, while in-hospital and three-month mortalities were 27% and 31% respectively. Higher pre-treatment SBP was positively correlated to increased FIV (r: +0.225; p=0.020). Patients with FFO had lower pretreatment SBP (151±24mmHg vs 165±28mmHg; p= 0.010), while pretreatment SBP levels were higher in patients who died during hospitalization (169±34mmHg vs 156±24mmHg; p=0.043). A 10mmHg increment in pretreatment SBP was independently (p=0.010) associated with an increase of 12cm3 in FIV (95%CI: 3-21) in multiple linear regression models adjusting for demographics, vascular risk factors, pretreatment DBP, admission NIHSS, intravenous thrombolysis, onset to revascularization and successful revascularization. A 10mmHg increment in pretreatment SBP was independently (p=0.012) associated with a lower likelihood of FFO at three months (OR: 0.64; 95%CI: 0.45-0.91) in multiple logistic regression models adjusting for multiple confounders.
Conclusion: Higher pretreatment SBP is an independent predictor of increased FIV and lower likelihood of three-month FFO in patients with ELVO who undergo EVT.