Key result
Every 10 mmHg increment in mean systolic blood pressure at the time of successful recanalization was independently associated with an increased risk of parenchymal hemorrhage type 2 (OR 1.973).
Why the study?
The study investigated the association between blood pressure at the time of recanalization and hemorrhagic transformation in large vessel occlusion patients following mechanical thrombectomy with general anesthesia.
Does higher blood pressure at successful recanalization increase the risk of parenchymal hemorrhage in LVO patients following mechanical thrombectomy with general anesthesia?
Observational (n=124)
No
Does higher blood pressure at successful recanalization increase the risk of parenchymal hemorrhage in LVO patients following mechanical thrombectomy with general anesthesia?
Odds Ratio: 1.973 (95% CI 1.19–3.271)
p-value: p=0.008
Higher systolic blood pressure and greater blood pressure variability at the time of successful recanalization are independently associated with an increased risk of severe parenchymal hemorrhage in patients with large vessel occlusion stroke undergoing mechanical thrombectomy under general anesthesia.
May support BP optimization at recanalization to limit hemorrhage; hypothesis-generating and requires prospective validation.
Background: To investigate the association between blood pressure (BP) at the time of recanalization and hemorrhagic transformation in large vessel occlusion (LVO) patients following mechanical thrombectomy (MT) with general anesthesia. Methods: We retrospectively reviewed our data base for patients with AIS who received MT between Jan 2018 and Dec 2019. The BP at two adjacent time points immediately after successful recanalization was recorded for subsequent calculation of mean BP (BPmean), maximum BP (BPmax), minimum BP (BPmin), range of BP (BPrange) and standard deviation of SP (BPSD). Hemorrhagic transformation was identified on 24-hour computerized tomography images according to European Cooperative Acute Stroke Study (ECASS) III trial. We use binary logistic regression analysis to investigate the association of BP parameters and the incidence of parenchymal hemorrhage (PH) and PH-2. Results: A total of 124 patients with anterior circulation LVO were finally included for analyses. After controlling for intravenous thrombolysis, procedure duration of mechanical thrombectomy, baseline NIHSS, baseline ASPECTS, and number of device passes, the results showed that every increment of 10 mmHg in SBPrange (OR 1.559; 95% CI 1.027 to 2.365; P=0.037) and SBPSD (OR 1.998; 95% CI 1.017 to 3.925; P=0.045) were independently associated with PH. After adjustment for intravenous thrombolysis, procedure duration of mechanical thrombectomy, baseline NIHSS, the results showed that every increment of 10 mmHg in SBPmean (OR 1.973; 95% CI 1.190 to 3.271; P =0.008), SBPmax (OR 1.838; 95% CI 1.199 to 2.815; P =0.005), SBPrange (OR 1.908; 95% CI 1.161 to 3.136; P =0.011) and SBPSD (OR 2.573; 95% CI 1.170 to 5.675; P =0.019) were independently associated with PH-2. Conclusion: Patients with higher systolic BP and variability at the time of successful recanalization were more likely to have PH-2 in LVO patients following MT with general anesthesia.
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Cheng et al. (2020) conducted an observational in Acute ischemic stroke with large vessel occlusion (n=124). Systolic blood pressure at successful recanalization vs. Lower systolic blood pressure was evaluated on Parenchymal hemorrhage type 2 (PH-2) at 24-36 hours (OR 1.973, 95% CI 1.190-3.271, p=0.008). Every 10 mmHg increment in mean systolic blood pressure at the time of successful recanalization was independently associated with an increased risk of parenchymal hemorrhage type 2 (OR 1.973).
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