Functional Outcomes Associated With Blood Pressure Decrease After Endovascular Thrombectomy

 Leaders would have demanded a protocol come out of this research. But then there are NO LEADERS anywhere in stroke! Don't plan on having a stroke for at least 50 years.

Functional Outcomes Associated With Blood Pressure Decrease After Endovascular Thrombectomy

Jae Wook Jung, MD¹; Kwang Hyun Kim, MD¹; Jaeseob Yun, MD¹; et al Young Dae Kim, MD, PhD¹; JoonNyung Heo, MD¹; Hyungwoo Lee, MD¹; Jin Kyo Choi, MD¹; Il Hyung Lee, MD¹; In Hwan Lim, MD¹; Soon-Ho Hong, MD¹; Byung Moon Kim, MD, PhD²; Dong Joon Kim, MD, PhD²; Na Young Shin, MD²; Bang-Hoon Cho, MD³; Seong Hwan Ahn, MD⁴; Hyungjong Park, MD⁵; Sung-Il Sohn, MD, PhD⁵; Jeong-Ho Hong, MD, PhD⁵; Tae-Jin Song, MD, PhD⁶; Yoonkyung Chang, MD, PhD⁷; Gyu Sik Kim, MD⁸; Kwon-Duk Seo, MD⁸; Kijeong Lee, MD⁸; Jun Young Chang, MD⁹; Jung Hwa Seo, MD¹⁰; Sukyoon Lee, MD¹⁰; Jang-Hyun Baek, MD¹¹; Han-Jin Cho, MD, PhD¹²; Dong Hoon Shin, MD, PhD¹³; Jinkwon Kim, MD, PhD¹⁴; Joonsang Yoo, MD¹⁴; Minyoul Baik, MD¹⁴; Kyung-Yul Lee, MD¹⁵; Yo Han Jung, MD, PhD¹⁵; Yang-Ha Hwang, MD, PhD¹⁶; Chi Kyung Kim, MD, PhD¹⁷; Jae Guk Kim, MD¹⁸; Chan Joo Lee, MD, PhD¹⁹; Sungha Park, MD, PhD^19,20; Soyoung Jeon, PhD²¹; Hye Sun Lee, PhD²¹; Sun U. Kwon, MD, PhD⁹; Oh Young Bang, MD, PhD²²; Ji Hoe Heo, MD, PhD¹; Hyo Suk Nam, MD, PhD¹

Author Affiliations Article Information

JAMA Netw Open. 2024;7(4):e246878. doi:10.1001/jamanetworkopen.2024.6878

Key Points

Question  Is a medication-induced blood pressure (BP) decrease (systolic BP <100 mm Hg) during the 24 hours after successful endovascular thrombectomy associated with poor outcomes in patients with ischemic stroke?

Findings  In a cohort study of 302 patients after successful endovascular thrombectomy, those experiencing medication-induced BP decreases exhibited a significantly lower odds of functional independence at 3 months (31.9%) compared with the no BP decrease group (49.1%), a significant difference. However, the odds of functional independence with spontaneous BP decrease did not significantly differ from those with no BP decrease.

Meaning  The findings of this study suggest that a medication-induced BP decrease during the first 24 hours after successful reperfusion with endovascular thrombectomy may be harmful for patients with acute ischemic stroke.

Abstract

Importance  The associations between blood pressure (BP) decreases induced by medication and functional outcomes in patients with successful endovascular thrombectomy remain uncertain.

Objective  To evaluate whether BP reductions induced by intravenous BP medications are associated with poor functional outcomes at 3 months.

Design, Setting, and Participants  This cohort study was a post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy–Optimal Blood Pressure Control trial, a comparison of intensive and conventional BP management during the 24 hours after successful recanalization from June 18, 2020, to November 28, 2022. This study included 302 patients who underwent endovascular thrombectomy, achieved successful recanalization, and exhibited elevated BP within 2 hours of successful recanalization at 19 stroke centers in South Korea.

Exposure  A BP decrease was defined as at least 1 event of systolic BP less than 100 mm Hg. Patients were divided into medication-induced BP decrease (MIBD), spontaneous BP decrease (SpBD), and no BP decrease (NoBD) groups.

Main Outcomes and Measures  The primary outcome was a modified Rankin scale score of 0 to 2 at 3 months, indicating functional independence. Primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and mortality due to index stroke within 3 months.

Results  Of the 302 patients (median [IQR] age, 75 [66-82] years; 180 [59.6%] men), 47 (15.6%)were in the MIBD group, 39 (12.9%) were in the SpBD group, and 216 (71.5%) were in the NoBD group. After adjustment for confounders, the MIBD group exhibited a significantly smaller proportion of patients with functional independence at 3 months compared with the NoBD group (adjusted odds ratio [AOR], 0.45; 95% CI, 0.20-0.98). There was no significant difference in functional independence between the SpBD and NoBD groups (AOR, 1.41; 95% CI, 0.58-3.49). Compared with the NoBD group, the MIBD group demonstrated higher odds of mortality within 3 months (AOR, 5.15; 95% CI, 1.42-19.4). The incidence of symptomatic intracerebral hemorrhage was not significantly different among the groups (MIBD vs NoBD: AOR, 1.89; 95% CI, 0.54-5.88; SpBD vs NoBD: AOR, 2.75; 95% CI, 0.76-9.46).

Conclusions and Relevance  In this cohort study of patients with successful endovascular thrombectomy after stroke, MIBD within 24 hours after successful recanalization was associated with poor outcomes at 3 months. These findings suggested lowering systolic BP to below 100 mm Hg using BP medication might be harmful.

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