Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

 So you didn't come up with a protocol but suggested future trials. What a waste of time and money. 

We need a protocol on blood pressure management post stroke. Too high, not good, too low, not good. Otherwise with no protocol your doctor is just guessing, you better hope they guess correctly.

High Systolic BP After EVT for Stroke Tied to Poor Outcomes December 2020

Low Blood Pressure Associated With Increased Risk of Death Following a Stroke

 November 2021

 

The latest waste here:

Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

 

Nils H. Petersen

,

Sreeja Kodali

,

Can Meng

,

Fangyong Li

,

Cindy Khanh Nguyen

,

Krithika U. Peshwe

,

Sumita Strander

,

Andrew Silverman

,

Alexandra Kimmel

,

Anson Wang

,

Mohammad Anadani

,

Eyad Almallouhi

, … See all authors

Originally published16 Nov 2021https://doi.org/10.1161/STROKEAHA.121.034408Stroke. 2021;0:STROKEAHA.121.034408

Abstract

Background and Purpose:

Elevated blood pressure after endovascular thrombectomy (EVT) has been associated with an increased risk of hemorrhagic transformation and poor functional outcomes. However, the optimal hemodynamic management after EVT remains unknown, and the blood pressure course in the acute phase of ischemic stroke has not been well characterized. This study aimed to identify patient subgroups with distinct blood pressure trajectories after EVT and study their association with radiographic and functional outcomes.

Methods:

This multicenter retrospective cohort study included consecutive patients with anterior circulation large-vessel occlusion ischemic stroke who underwent EVT. Repeated time-stamped blood pressure data were recorded for the first 72 hours after thrombectomy. Latent variable mixture modeling was used to separate subjects into five groups with distinct postprocedural systolic blood pressure (SBP) trajectories. The primary outcome was functional status, measured on the modified Rankin Scale 90 days after stroke. Secondary outcomes included hemorrhagic transformation, symptomatic intracranial hemorrhage, and death.

Results:

Two thousand two hundred sixty-eight patients (mean age [±SD] 69±15, mean National Institutes of Health Stroke Scale 15±7) were included in the analysis. Five distinct SBP trajectories were observed: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%). SBP trajectory group was independently associated with functional outcome at 90 days (P<0.0001) after adjusting for potential confounders. Patients with high and high-to-moderate SBP trajectories had significantly greater odds of an unfavorable outcome (adjusted odds ratio, 3.5 [95% CI, 1.8–6.7], P=0.0003 and adjusted odds ratio, 2.2 [95% CI, 1.5–3.2], P<0.0001, respectively). Subjects in the high-to-moderate group had an increased risk of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.82 [95% CI, 1–3.2]; P=0.04). No significant association was found between trajectory group and hemorrhagic transformation.

Conclusions:

Patients with acute ischemic stroke demonstrate distinct SBP trajectories during the first 72 hours after EVT that have differing associations with functional outcome. These findings may help identify potential candidates for future blood pressure modulation trials.