Association between systolic blood pressure parameters and unexplained early neurological deterioration (UnND) in acute ischemic stroke patients treated with mechanical thrombectomy

We don't just need to know the association. Leaders would put into action the research needed to prevent early neurological deterioration. But you're not leaders; ARE YOU? 

So you described a problem, offered no solution, didn't suggest further research; USELESS. And didn't even consider that early neurological deterioration might be caused by all the neurons dying because you've done nothing to stop the 5 causes of the neuronal cascade of death in the first days.

 

Association between systolic blood pressure parameters and unexplained early neurological deterioration (UnND) in acute ischemic stroke patients treated with mechanical thrombectomy

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Aleksandras Vilionskis, Virginija Gaigalaite, Lukas Salasevicius, ...

First Published June 16, 2022 Research Article 

https://doi.org/10.1177/17562864221093524

Article information

Abstract

Background:

Neurological deterioration (ND) after mechanical thrombectomy (MT) of acute ischemic stroke (AIS) in anterior circulation is an important complication associated with a poor outcome. Moreover, evident causes of ND may remain unexplained (UnND).

Objective:

We sought to evaluate the association of the systolic blood pressure (SBP) parameters before MT, during MT, and during a 24-h period after MT with UnND.

Methods:

We analyzed 382 MT-treated AIS patients in two stroke centers from 2017 to 2019. The patients with unsuccessful recanalization and/or with symptomatic intracerebral hemorrhage after MT were excluded. Multivariate logistic regression analysis was used to identify the SBP parameters that predict UnND.

Results:

There were 5.9% patients with UnND within 24 h after MT among patients with successful recanalization what comprises 4.9% of all patients who had undergone MT. SBP > 180 mmHg on admission (odds ratio (OR): 4, 95% confidence interval (CI): 1.6–10, p = 0.004) and a drop of SBP below100 mmHg during MT (OR: 4.7, 95% CI: 1.3–17, p = 0.019) were associated with UnND occurrence within 7 days without a significant association with UnND within 24 h. UnND within 7 days was predicted by the episodes of SBP exceeding the level of SBP observed before the groin puncture and occurring over the first 2 h following recanalization (OR: 5, 95% CI: 1.3–19, p = 0.021), an increase of SBP of more than 20% within 2–24 h after MT (OR: 3.4, 95% CI: 1.1–10, p = 0.035), and a drop of SBP below 100 mmHg after MT (OR: 3.2, 95% CI: 1.1–9, p = 0.039).

Conclusion:

The association between the SBP parameters and UnND depends on the treatment period and the time of UnND occurrence. The J/U resembling relationship between SBP and UnEND was established during a 24-h period after MT.

Keywords

blood pressure, mechanical thrombectomy, neurological deterioration, stroke

Introduction

Mechanical thrombectomy (MT) alone or combined with intravenous tPA (tissue-type plasminogen activator) is one of the most effective treatments(Your definition of effective is completely fucking wrong! Survivor definition of effective is 100% recovery! You're using the tyranny of low expectations to declare success when it doesn't exist.) for acute ischemic stroke (AIS) in patients with large-vessel occlusion of the anterior circulation. Despite successful recanalization via MT, some patients develop early neurological deterioration (ND). An increase in ⩾4 points of the National Institutes of Health Stroke Scale (NIHSS) between pretreatment and Day 1 is commonly considered as an early ND,^1–4 though for minor stroke patients an increase in ⩾2 points of the NIHSS is considered as ND.^1–5 Several studies demonstrated that early or subacute ND is a strong predictor of poor stroke outcomes.⁶ Apart from obvious causes such as lack of recanalization, parenchymal hemorrhage, malignant edema, or procedural complications, ND might remain unexplained in over half of cases (UnND).^2–4 Although hemodynamic factors are suspected as important mechanisms of ND, this has not been directly examined to date. Therefore, there are currently no management guidelines for UnND.

Several studies^5,7–12 demonstrated an association between different blood pressure (BP) parameters in periprocedural period and a clinical outcome or hemorrhagic complications. However, due to heterogeneity of studies, it is still unknown whether steady parameters (different BP thresholds) or dynamic parameters (BP variability, which takes into account various BP variations) before, during, and after MT have the same impact on prognosis. In addition, the type of relationship (J/U shaped or other) between systolic blood pressure (SBP) and the outcome is a matter of discussion. Therefore, there is no clear consensus for the optimal BP control before, during, and after MT.^13,14

The association between BP parameters in periprocedural period and UnND has been scarcely studied; therefore, their impact on UnND at different treatment phases is unclear. Girot et al.² noted that the higher baseline SBP was associated with UnND within 24 h, despite the exclusion of patients with early symptomatic intracranial hemorrhage (sICH). Although blood pressure variability (BPV) during a 24-h period after MT was associated with poor clinical outcomes and is most likely to be apparent in patients who have been successfully recanalized,⁵ the association of BPV and ND is less clear, and the results are controversial.^15,16

We aimed to investigate the association of various dynamic and steady SBP parameters with UnND in patients with successful recanalization and without hemorrhagic transformations in different treatment phases.