Introduction: Elevated Blood pressure (BP) is known to be related to hemorrhagic transformation (HT) after ischemic stroke. However, the effect of BP variation on the HT remains unclear, especially in patients with successful recanalization after mechanical thrombectomy.
Hypothesis: Therefore, we investigated the relationship between BP and HT after mechanical thrombectomy following ischemic stroke.
Methods: A consecutive 141 patients with acute ischemic stroke and successful recanalization (TICI 2b or TICI 3) were included for the analysis between January 2013 and November 2016. The information on BP was obtained over the first 24 hours using various parameters including mean, maximum (max), minimum (min), difference between max and min (max– min), standard deviation (SD), coefficient of variation (CV), and successive variations (SV) for systolic, diastolic BP, and mean BP. We defined major HT as a parenchymal hematoma type 2 (PH2).
Result: Among the included patients (age, 66.3; and male. 55.2%), 16 patients (11.3%) developed major HT over the first 24 hours after successful recanalization. Systolic BP max-minwas significantly increased in patients with major HT compared to those without major HT (61.2 mmHg vs. 44.2 mmHg, P = 0.034) while other BP parameters were not. In addition, systolic BP max-minwas significantly associated with symptomatic HT (n=11, 7.8%, P = 0.007). After adjusting for confounders, systolic BP max-minwas independently associated with major HT (Odds ratio, 1.028; 95% confidence interval, 1.004-1.051).
Conclusions: Our results demonstrated that absolute change of systemic BP over the first 24 hours was associated with major and symptmatic HT after successful mechanical thrombectomy after acute ischemic stroke. This suggests that maintaining stable systolic BP is an important factor in possibly preventing major HT after successful recanalization.