Key result
Every 1 minute extension in duration of mean arterial pressure drop more than 10 mmHg during general anesthesia increased the odds of poor 90-day outcome by 1.3% (OR 1.013).
Why the study?
Optimal periprocedural blood pressure management during mechanical thrombectomy remains controversial, and the impact of the duration of blood pressure drops under general anesthesia on outcomes was unclear.
Does prolonged duration of blood pressure drops during general anesthesia worsen 90-day functional outcomes in LVO patients treated with mechanical thrombectomy?
Observational (n=131)
No
Does prolonged duration of blood pressure drops during general anesthesia worsen 90-day functional outcomes in LVO patients treated with mechanical thrombectomy?
Effect estimate: OR 1.013 (95% CI 1.004-1.023)
p-value: p=0.007
Prolonged intraprocedural mean arterial pressure drops >10 mmHg during general anesthesia for mechanical thrombectomy are associated with worse 90-day functional outcomes in patients with large vessel occlusion.
Prolonged MAP drops during GA for MT were associated with poorer outcomes; hypothesis-generating and requires confirmation in randomized trials.
Background and Purpose: Optimal periprocedural management of blood pressure during mechanical thrombectomy (MT) remains controversial. This study aimed to investigate the relationship between the duration of blood pressure drops during general anesthesia and the outcomes in large vessel occlusion (LVO) patients treated with MT. Methods: We retrospectively reviewed our prospectively collected data for LVO patients treated with MT between January 2018 and July 2020. Intraprocedural mean arterial pressure (MAP) was recorded every 5 min throughout the procedure. Baseline MAP minus each MAP value recorded during general anesthesia was defined ΔMAP. Cumulated time (in min) and longest continuous episode (in min) with ΔMAP more than 10, 15, 20, 25, and 30 mmHg were calculated, respectively. Poor outcome was defined as 90-day modified Rankin score (mRS) 3–6. Associations between cumulated time of different ΔMAP thresholds and poor outcome were determined using binary logistic regression models. Results: A total of 131 patients were finally included in the study. After controlling for age, atrial fibrillation, baseline NIHSS, baseline ASPECTS, procedure duration of MT, and times of retrieval attempts, the results indicated that cumulated time of MAP drop more than 10 mmHg (OR 1.013; 95% CI 1.004–1.023; P = 0.007) and 15 mmHg (OR 1.011; 95% CI 1.002–1.020; P = 0.017) were independently associated with poor outcomes. Conclusion: Prolonged episodes of intraprocedural MAP lowering were more likely to have poor outcomes in LVO patients following MT with general anesthesia, which might be helpful in guiding intraprocedural hemodynamic management of patients under general anesthesia.
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Xu et al. (2021) conducted an observational in Acute ischemic stroke with large vessel occlusion (n=131). Prolonged duration of mean arterial pressure (MAP) drop during general anesthesia vs. Shorter duration of MAP drop was evaluated on Poor outcome (90-day mRS 3-6) (OR 1.013, 95% CI 1.004-1.023, p=0.007). Every 1 minute extension in duration of mean arterial pressure drop more than 10 mmHg during general anesthesia increased the odds of poor 90-day outcome by 1.3% (OR 1.013).
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