Background: Presently, no evidence exists that blood pressure parameters (BPPs) in the first 24-hours after thrombectomy (T24hrs) independently predicts outcome. We aimed to study an association between discharge outcome and BPPs in T24hrs for both successful and unsuccessful thrombectomies, defined as Thrombolysis in Cerebral Infarction (TICI) score ≥ 2b and ≤ 2a, respectively.
Methods: We retrospectively identified 54 patients at a single institution who underwent thrombectomy for emergent occlusion of anterior cerebral circulation (ICA, A1, M1, M2) from May 2015 to June 2016. We excluded patients with cancer or major cardiovascular surgeries. Primary outcome was hospital discharge: home or rehab (favorable) versus long term acute care facility or death (unfavorable). We determined if highest, lowest, average, and range of systolic (SBP), diastolic (DBP), and mean arterial (MAP) pressures were associated with outcome, utilizing univariate and multivariate logistic regression considering the following variables: age, sex, NIH-stroke scale, history of hypertension, hyperlipidemia, diabetes, smoking, atrial fibrillation, use of anticoagulative or antiplatelet medications prior to admission, administration of tPA, and the use of antihypertensive or pressor drip in T24hrs.
Results: In patients with TICI ≥ 2b (n=43), highest SBP (odds ratio=1.04, p=0.01), highest MAP (1.05, p=0.03), SBP range (1.04, p=0.005), and MAP range (1.05, p=0.03) correlated with poor outcome. In multivariate analysis, only the SBP range trended with outcome (1.34, p=0.09). In patients with TICI ≤ 2a (n=11), BPPs did not correlate with outcome.
Conclusion: Large variability in SBP in T24hrs after successful thrombectomies (TICI ≥ 2b) trended with poor outcome. Further studies are warranted to elucidate BPPs in T24hrs as predictors of hospital discharge.