High Systolic BP After EVT for Stroke Tied to Poor Outcomes

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High Systolic BP After EVT for Stroke Tied to Poor Outcomes

Higher maximum systolic blood pressures during the first 6 hours after endovascular treatment (EVT) are associated with worse functional outcomes in patients with acute ischemic stroke, a new study suggests.

High blood pressure during this period was also associated with increased risk of symptomatic intracranial hemorrhage (sICH) and a more severe early neurologic deficit.

These findings were presented at the European Stroke Organization-World Stroke Organization (ESO-WSO) Conference 2020.

Patients who present with ischemic stroke often have elevated blood pressure. Although blood pressure facilitates cerebral perfusion and improved outcomes, excessive blood pressure could cause hemorrhage. Little data are available about the relationship between blood pressure in the first hours after EVT and subsequent patient outcomes.

Noor Samuels, MD, of the Departments of Radiology & Neurology of the Erasmus MC University Medical Center in Rotterdam, the Netherlands, and colleagues sought to investigate this relationship and to assess whether the associations between blood pressure and outcomes were influenced by reperfusion grade.

The investigators analyzed data from the MR CLEAN registry, which included all patients who underwent EVT for ischemic stroke in the Netherlands. They included patients treated between March 2014 and November 2017 in their analysis. To reduce the risk of confounding by indication, Samuels and colleagues focused on eight centers that systematically recorded blood pressure values after EVT. They evaluated patients' mean, maximum, and minimum systolic blood pressure during the first 6 hours after EVT.

The study's primary outcome was the modified Rankin Scale score at 90 days. Samuels and colleagues also examined early neurologic deficit, which they defined as NIH Stroke Scale score at 24 to 48 hours, and sICH later than 6 hours after EVT as secondary outcomes.

Researchers performed a multivariable regression analysis, adjusted for center and potential confounders, to evaluate the association between systolic blood pressure with each outcome. The potential confounders they considered were age, collateral score, medical history, and baseline stroke severity. They also tested for interactions between systolic blood pressure parameters and recanalization status.

They evaluated whether the association between blood pressure and outcome was modified by reperfusion grade, which they defined using the extended thrombolysis in cerebral infarction score.

Linear Association

Samuels and colleagues identified 1796 patients in the registry and included 1161 in their analysis. They excluded patients who were younger than 18 years, those with stroke in the posterior circulation, and those for whom no blood pressure data were available.