Abstract Details

Title Short-term Blood Pressure Variability After Successful Re-canalization Is Associated with Discharge Outcomes in Large Vessel Occlusion Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Cerebrovascular Disease: Large Vessel Occlusions and Thrombectomy (4:06 PM-4:18 PM)

Poster/Presentation
Number 004

Objective Our objective was to assess the role of blood pressure (BP) variability in predicting discharge outcomes in successfully re-canalized (TICI 2b-3) large vessel occlusion strokes (LVOs) strokes.

Background Blood pressure variability affects early neurological deterioration and clinical outcomes in acute ischemic stroke. Evidence to guide post re-canalization blood pressure changes is currently lacking.

Design/Methods The study includes retrospective analysis of 182 LVO stroke patients between the years 2015-19. Anterior circulation LVO stroke patients, who were successfully re-canalized (TICI 2b-3) within 6 hours of time since last seen normal were included in this retrospective analysis (n=87). BP measurements were collected hourly for the first 24 hours post re-canalization. Squared average real BP variability (ARV²) was calculated for systolic (SBP) and mean blood pressures (MAP). We compared four quartiles of ARV² (Q1 the least and Q4 highest variability) using dichotomous outcome variables - modified Rankin Scale (mRS) < 2; and mRS > 5. The outcomes were adjusted for potential confounders including age, tPA, use of General Anesthesia (GA) and hemorrhagic events.

Results All four ARV² quartiles had similar baseline characteristics. Favorable outcomes (mRS ≤ 2) were significantly higher (aOR: 0.17 [0.03 – 0.80], p=0.034) in Q1 of the ARV² MAP (45%) compared to the Q4 patients (18%). While 50% of patients in SBP ARV² Q1 had favorable outcomes (i.e., mRS ≤ 2), only 23% of Q4 patients experienced such outcomes. (0.32 [0.08 – 1.20],p= 0.100) SBP ARV² result was not statistically significant, though followed expected direction.

Conclusions Less blood pressure variability (ARV²) for MAP- in the first 24 hours after TICI 2b-3 re-canalization of LVOs is associated with a discharge mRS ≤ 2. Impact of blood pressure variability (ARV²) on long-term functionality outcomes in successfully re-canalized LVO stroke patients needs further detailed exploration.

Authors/Disclosures
Saurav Das, MD (Washington University in St. Louis) PRESENTER	Dr. Das has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Wei Liu, MD	Dr. Liu has nothing to disclose.
Kerri S. Remmel, MD, PhD (Regional Brain Institute)	Dr. Remmel has nothing to disclose.
	No disclosure on file

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