Abstract Details

Title Risk of Worse Outcome in Stroke Patients with High Blood Pressure Variability After Endovascular Thrombectomy May Be Amplified by Impaired Cerebral Autoregulation

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Cerebrovascular Disease: Large Vessel Occlusions and Thrombectomy (4:42 PM-4:54 PM)

Poster/Presentation
Number 007

Objective To examine the effect of impaired cerebral autoregulation on the risk of worse outcome after endovascular thrombectomy (EVT) in large-vessel occlusion (LVO) stroke patients with high blood pressure (BP) variability.

Background Both increased BP variability and impaired autoregulation have been associated with increased risk of poor outcome after EVT. The combined effect of these two variables, however, has not yet been elucidated.

Design/Methods We prospectively enrolled patients with LVO stroke undergoing EVT. Autoregulatory function was continuously measured for up to 48 hours post-EVT by interrogating changes in near-infrared spectroscopy-derived tissue oxygenation (a cerebral blood flow surrogate) in response to changes in BP. BP variability was assessed using the standard deviation of the mean. Values were averaged for the entire recording period and dichotomized based on the median. Functional outcome was assessed using the modified Rankin scale (mRS) at 90 days. We examined the association between BP variability, autoregulatory function, and outcome using ordinal logistic regression, adjusting for age and admission NIHSS.

Results Ninety-five patients (mean age 71, NIHSS 14, monitoring time 28±18 hours) were included. BP variability (p=0.043) and autoregulation (p=0.04) were each independently associated with functional outcome. Among patients with high BP variability, worse autoregulation was independently associated with higher (worse) mRS scores at 90 days (OR 3.9, 95% CI 1.1-14.5, p=0.036). The proportion of favorable outcome was highest among patients with low BP variability and better autoregulation (50%), and lowest among those with high BP variability and worse autoregulation (11%, p=0.073).

Conclusions For LVO stroke patients with high BP variability after EVT, worse functional outcome may be exacerbated by impaired autoregulation. These results suggest that autoregulatory status should be considered in the management of BP after EVT to help identify high-risk patients and develop individualized blood pressure management plans to improve outcomes.

Authors/Disclosures
Cindy Khanh P. Nguyen (Yale University) PRESENTER	Miss Nguyen has nothing to disclose.
	No disclosure on file
Anson Wang, MD (Massachusetts General Hospital)	Dr. Wang has nothing to disclose.
Sreeja Kodali	Ms. Kodali has nothing to disclose.
Sumita M. Strander	Ms. Strander has nothing to disclose.
Alexandra Kimmel	No disclosure on file
Krithika Umesh Peshwe, MD (West Virginia University School of Medicine)	Dr. Peshwe has nothing to disclose.
Adam De Havenon, MD, FAAN (Yale University)	Dr. De Havenon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Novo Nordisk. Dr. De Havenon has stock in Certus. Dr. De Havenon has stock in TitinKM. The institution of Dr. De Havenon has received research support from NIH/NINDS. Dr. De Havenon has received publishing royalties from a publication relating to health care.
Emily J. Gilmore, MD (Yale University School of Medicine)	Dr. Gilmore has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for carpl.ai. Dr. Gilmore has received personal compensation in the range of $0-$499 for serving as a Consultant for AAN. Dr. Gilmore has received research support from NIH.
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.
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.
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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