Invasive monitoring of arterial blood pressure in cerebral arteries during thrombectomy

Objective: to assess the arterial blood pressure measured invasively in the internal carotid artery and distal to the site of thrombotic occlusion (in the middle cerebral artery) during mechanical thrombectomy in patients with acute ischemic stroke. Materials and methods: In 2024, a total of 90 patients with acute cerebrovascular occlusion who underwent thrombectomy were examined. Data from 23 patients in whom intraoperative arterial pressure (AP) was measured invasively were analyzed. Patient age ranged from 44 to 81 years, with a mean age of 66.3±10.4 years. The majority of patients were male (61%). Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and functional outcomes were evaluated using the modified Rankin Scale (mRS) at discharge (0–3 points – favorable outcome, 4–6 points – unfavorable outcome). Ischemic changes were graded according to the Alberta Stroke Program Early CT Score (ASPECTS), with ≤7 points indicating extensive changes and ≥8 points indicating moderate changes. Results: No statistically significant differences were found in AP levels in the internal carotid artery before and after thrombectomy depending on the degree of neurological deficit, volume of ischemic changes, or functional outcome (p>0.1). The mean AP measured distal to the site of occlusion was significantly higher in patients with NIHSS scores ≤15 compared to those with NIHSS scores>15 ((59.7±4.7) vs. (51.0±10.9) mm Hg, p=0.02), in patients with moderate ischemic changes ((58.5±5.4) vs. (44.3±11.9) mm Hg, p=0.03), and in those with a favorable functional outcome ((59.2±5.5) vs. (49.0±11.1) mm Hg, p=0.02). The mean AP in the internal carotid artery after thrombectomy was significantly higher in patients with hemorrhagic transformation ((114.4±9.0) vs. (100.4±13.4) mm Hg, p=0.01). Conclusions: A correlation was found between the mean AP levels, measured invasively in intracranial arteries at various stages of mechanical thrombectomy for acute ischemic stroke, and stroke severity, infarct volume, development of hemorrhagic transformation, and functional outcome. These findings highlight the importance of investigating local hemodynamics to predict treatment outcomes in acute ischemic stroke and to explore personalized AP management strategies during thrombectomy and in the early postoperative period.