Deans' stroke musings: Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, March 10, 2021

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status

So NO PROTOCOLS came out of this.

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status

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Xianjun Huang *

, Hongquan Guo *, Lili Yuan *, ...

First Published March 5, 2021 Research Article https://doi.org/10.1177/1756286421997383

Article information

Abstract

Background:

Blood pressure (BP), recanalization status, and collateral circulation are important factors for cerebral autoregulation after stroke. We aimed to investigate the association of various BP variability (BPV) parameters with clinical outcomes after mechanical thrombectomy (MT) according to recanalization and collateral status.

Methods:

We included 502 consecutive patients who underwent MT due to anterior circulation large vessel occlusion stroke at three comprehensive stroke centers. BPV parameters were standard deviation (SD), maximum/minimum BP, coefficient of variation (CV) and successive variation (SV). The clinical outcomes included 90-day functional outcome assessed by modified Rankin Scale score and symptomatic intracranial hemorrhage (sICH).

Results:

Among the included patients, 219 (43.6%) achieved good functional outcomes and 59 (11.8%) developed sICH. After adjusting for confounders, higher systolic BP (SBP) variability [CV (odds ratio (OR), 1.089, p = 0.035), SV (OR, 1.082, p = 0.004). and SD (OR, 1.074, p = 0.027)] was associated with a lower likelihood of a favorable outcome. In addition, higher SBP [CV (OR, 1.156, p = 0.001) and SD (OR, 1.118, p = 0.001)] were significantly associated with increased odds of sICH. Moreover, the relationship between BPV and the outcomes depended on recanalization status. However, regardless of collateral status, a higher BPV after MT was associated with worse outcomes.

Conclusions:

Higher SBP SD and CV during the first 24 h after MT was a powerful predictor of worse clinical outcomes, regardless of the collateral status. However, the effects of BPV on outcomes were more substantial among patients with successful reperfusion.

Keywords blood pressure, mechanical thrombectomy, prognosis, stroke, variability

Introduction

Mechanical thrombectomy (MT) has become the current standard of care for patients with large vessel occlusion stroke (LVOS) of the anterior circulation.¹ Nevertheless, in the real world, nearly half of patients with successful MT still may not achieve functional improvement.^2,3 Several confounders affecting the outcome of stroke have been recognized. Of the confounders, postprocedural blood pressure (BP) may be a relevant factor regarding the outcome.⁴ Moreover, BP is a readily modifiable parameter with the potential to improve outcomes in patients with MT.^5,6 Unfortunately, the optimal BP management after the endovascular procedure is currently unknown.⁷

For patients with LVOS, cerebral autoregulation is impaired.⁸ The fate of the ischemic penumbra mainly depends on the maintenance of proper cerebral perfusion. In this process, BP, recanalization status, and collateral circulation are three largely important interrelated factors.⁹ Although findings from prior studies suggested that either a decrease or an increase in BP during the MT perioperative period may lead to adverse outcomes,^10,11 the substantial association of BP with outcomes based on recanalization and collateral status in patients treated with MT remains to be unestablished. Accordingly, the existing guidelines still recommend maintaining a BP level of <180/105 for 24 h after MT,¹ which is based on intravenous thrombolysis (IVT).

BP variability (BPV) could fully reflect the real BP status of acute stroke. Moreover, BPV has been considered to be an emerging risk factor for poor outcome after stroke.¹² Although several studies have shown the association of BPV and outcomes after MT,^13–15 most studies are limited by retrospective single-center design, inclusion of anterior and posterior circulation, and few using the modern thrombectomy device. In addition, based on recanalization and collateral status, the effect of BPV after thrombectomy on outcomes is still unclear.

In view of these considerations, we performed a multicenter cohort study of Chinese patients by a prospective registry. We aimed to investigate the association of various BPV parameters with clinical outcomes according to recanalization and collateral status.