Association between blood pressure and endovascular treatment outcomes differs by baseline perfusion and reperfusion status

• Published in: Scientific reports Vol. 13; no. 1; pp. 13776 - 10
• Main Authors: Kim, Beom Joon, Singh, Nishita, Kim, Hyeran, Menon, Bijoy K., Almekhlafi, Mohammed, Ryu, Wi-Sun, Kim, Joon-Tae, Kang, Jihoon, Baik, Sung Hyun, Kim, Jun Yup, Lee, Keon-Joo, Jung, Cheolkyu, Han, Moon-Ku, Bae, Hee-Joon
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 23.08.2023; Nature Publishing Group; Nature Portfolio
• Subjects: 692/4019/592/75/243; 692/617/375/534; Blood pressure; Cardiovascular system; Clinical outcomes; Coefficient of variation; Health sciences; Hospitals; Humanities and Social Sciences; Ischemia; multidisciplinary; Neurology; Perfusion; Reperfusion; Review boards; Science; Science (multidisciplinary); Stroke
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-023-40572-0

We hypothesized that the association between BP and endovascular treatment (EVT) outcomes would differ by baseline perfusion and recanalization status. We identified 388 ICA or M1 occlusion patients who underwent EVT ≤ 24 h from onset with successful recanalization (TICI ≥ 2b). BP was measured at 5-min intervals from arrival and during the procedure. Systolic BPs (SBP) were summarized as dropmax (the maximal decrease over two consecutive measurements), incmax (the maximal increase), mean, coefficient of variation (cv), and standard deviation. Adequate baseline perfusion was defined as hypoperfusion intensity ratio (HIR) ≤ 0.5; infarct proportion as the volume ratio of final infarcts within the T max  > 6 s region. In the adequate perfusion group, infarct proportion was closely associated with SBP dropmax (β ± SE ( P -value); 1.22 ± 0.48, (< 0.01)), SBP incmax (1.12 ± 0.33, (< 0.01)), SBP cv (0.61 ± 0.15 (< 0.01)), SBP sd (0.66 ± 0.08 (< 0.01)), and SBP mean (0.71 ± 0.37 (0.053) before recanalization. The associations remained significant only in SBP dropmax , SBP incmax , and SBP mean after recanalization. SBP incmax , SBP cv and SBP sd showed significant associations with modified Rankin Scale score at 3 months in the pre-recanalization period. In the poor perfusion group, none of the SBP indices was associated with any stroke outcomes regardless of recanalization status. BP may show differential associations with stroke outcomes by the recanalization and baseline perfusion status.