Abstract Details

Title Blood Pressure Decreases Occur Throughout Endovascular Thrombectomy and Are Associated with Poor Functional Outcome

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Cerebrovascular Disease: Large Vessel Occlusions and Thrombectomy (4:30 PM-4:42 PM)

Poster/Presentation
Number 006

Objective To characterize the timing of blood pressure decreases during thrombectomy for large-vessel occlusion stroke and assess their association with functional outcome.

Background Decreases in blood pressure (BP) during endovascular thrombectomy (EVT) are associated with infarct progression and poor outcome. The largest BP reductions are thought to occur during induction. The frequency and clinical relevance of late BP decreases after partial reperfusion has been achieved remain unknown.

Design/Methods We retrospectively studied patients with LVO stroke who underwent EVT at two comprehensive stroke centers. BP was continuously monitored throughout the procedure and averaged for selected time points. Maximum BP drop was calculated as the difference between admission systolic BP (SBP) and lowest SBP during EVT and assigned to one of three intervals: 1) arrival to angiography suite to groin puncture, 2) groin puncture to first pass, and 3) first pass to recanalization. Functional outcome was assessed using the modified rankin scale (mRS) at 90 days. Associations with the outcome were analyzed using ordinal logistic regression and adjusted for the size of the maximum drop in SBP.

Results 400 patients (age 71.3±14, 57% female, mean NIHSS 17) were included. Mean SBP for all patients decreased from EVT start to first procedural angiogram and then stabilized (Figure 1A). While the majority of blood pressure reductions occurred during interval 1 and 2 (n=253, 70%), 30% took place after first pass. We found no relation between timing of BP reduction and outcome (p=0.780, Figure 1B). Decreases in SBP during all intervals were significantly associated with 90-day outcome (OR per 10 mmHg 1.2, p=0.013; OR 1.1, p=0.025; and OR 1.3, p=0.011 for interval 1-3, respectively).

Conclusions BP drops occur throughout EVT, including between first pass and recanalization. Regardless of when these drops occur, they associate with poor outcome and thus underline the importance of blood pressure management throughout the procedure.

Authors/Disclosures
Alexandra Kimmel PRESENTER	No disclosure on file
	No disclosure on file
Sreeja Kodali	Ms. Kodali has nothing to disclose.
Sumita M. Strander	Ms. Strander has nothing to disclose.
Cindy Khanh P. Nguyen (Yale University)	Miss Nguyen has nothing to disclose.
Krithika Umesh Peshwe, MD (West Virginia University School of Medicine)	Dr. Peshwe has nothing to disclose.
Anson Wang, MD (Massachusetts General Hospital)	Dr. Wang has nothing to disclose.
Gloria V. Lopez Cardenas, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
Sudeepta Dandapat, MD (Aurora Neurosciences Innovation Institute)	Dr. Dandapat has nothing to disclose.
Lauren H. Sansing, MD	Dr. Sansing has nothing to disclose.
Joseph L. Schindler, MD (Yale University Department of Neurology)	Dr. Schindler has received personal compensation for serving as an employee of Aeromics. Dr. Schindler has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for Aeromics. Dr. Schindler has received stock or an ownership interest from Aeromics. Dr. Schindler has received publishing royalties from a publication relating to health care.
Guido J. Falcone, MD (Yale School of Medicine)	The institution of Dr. Falcone has received research support from NIH. The institution of Dr. Falcone has received research support from AHA.
Charles Matouk	Charles Matouk has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Silk Road Medical. Charles Matouk has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Microvention. Charles Matouk has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Navigantis.
Kevin N. Sheth, MD, FAAN (Yale UniversityDivision of Neuro and Critical Care)	Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. Dr. Sheth has received stock or an ownership interest from Astrocyte. Dr. Sheth has received stock or an ownership interest from Alva. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Nils Petersen, MD (Yale University)	The institution of Dr. Petersen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Silkroad Medical. Dr. Petersen has received research support from NIH.

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