Background: Endovascular treatment (EVT) has been shown to significantly improve functional outcome in patients with acute large cerebral vessel occlusions. To date, no evidence based recommendations on blood pressure management after successful EVT exist. Previous studies showed an association between high pre-EVT systolic blood pressure (SBP) and functional outcome, but do not answer the question on how to manage blood pressure after successful recanalization.
Methods: Prospectively derived data from patients with acute large vessel occlusion within the anterior circulation and EVT was analyzed in this monocentric study. Mean systolic- and maximum SBP as well as SBP-peaks have been obtained for the first 24 hours after successful EVT. Predictive value of SBP for discharge National Institute of Health Stroke Scale (NIHSS)-reduction of ≥50% and discharge modified Rankin scale (mRS) ≤2 has been investigated using logistic regression models and Receiver Operating Characteristic Curve analysis.
Results: From 168 patients with successful EVT, 95 (56.5%) had favorable NIHSS-based- and 74 (44%) a favorable mRS-based outcome. Mean- (NIHSS-group: 127 vs 132 mmHg, p=0.024; mRS-group: 127 vs 131 mmHg, p=0.035) and maximum SBP (NIHSS-group: 159 vs 170 mmHg, p<0.001; mRS-group: 157 vs 169 mmHg, p<0.001) as well as number of SBP peaks (NIHSS-group: 0 vs 2, p=0.003; mRS-group: 0 vs 1.5, p=0.004) were lower in patients with favorable outcome. Multivariable logistic regression showed high SBP to predict unfavorable outcome. Cut-off mean SBP was 140.5 mmHg and maximum SBP 159 mmHg.
Maier et al., Systolic blood pressure and outcome after EVT, abstract page 2
Conclusions: High SBP in the first 24 hours after recanalization of acute anterior cerebral vessel occlusions is associated with unfavorable functional outcome. Interventional studies are needed to determine the role of SBP management as a modifiable parameter in the early phase after successful EVT.