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Abstract Details

Patients with Parenchymal Hemorrhagic Transformation and Poor Functional Outcome Have Distinct Systolic Blood Pressure Trajectories 72 hours After Mechanical Thrombectomy
Cerebrovascular Disease and Interventional Neurology
P5 - Poster Session 5 (5:30 PM-6:30 PM)
3-007

To understand how blood pressure trajectories after mechanical thrombectomy predict patient outcome

Current stroke guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg after thrombolysis, and this standard has carried over for post-thrombectomy blood pressure (BP) management. However, optimal BP management after mechanical thrombectomy (MT) remains unclear and BP beyond 24 hours after thrombectomy is not well-studied. We investigated how 72-hour SBP trajectories after MT may predict patient outcome.
We retrospectively studied patients with large-vessel occlusion stroke who underwent MT. BP was recorded non-invasively for the first 72 hours. Parenchymal hemorrhagic transformation (HT) was measured on 24-hour CT scans using ECASS II classification. Functional outcome was assessed using the modified Rankin scale (mRS). SBP trajectories between groups were compared using generalized estimating equations. All analyses were adjusted for age, sex, admission NIHSS, tPA, TICI score and final infarct volume. Associations between SBP and HT was assessed using binary logistic regression.

Two hundred seventy-six patients (mean age 72±15, 154F, mean NIHSS 16, TICI 2B/3 n=195) were analyzed. Patients with poor discharge outcome (mRS>2) demonstrated distinct SBP trajectories over the first 72 hours (p=0.01). Patients with poor discharge outcome had higher SBP directly after MT, and their pressures dropped less during the first 12 hours when compared to those with favorable outcomes (mean 123 vs. 132 mmHg, p<0.01). Maximum SBP during the first 24 hours after reperfusion was independently associated with parenchymal type HT after adjusting for important covariates (p=0.04).

During the first 72 hours after MT, acute ischemic stroke patients show distinct SBP trajectories, which differ in relation to functional outcome and hemorrhagic transformation. These findings may help identify potential candidates for future blood pressure control trials.
Authors/Disclosures
Sreeja Kodali
PRESENTER 		Ms. Kodali has nothing to disclose.
Sumita M. Strander Ms. Strander has nothing to disclose.
No disclosure on file
Tijil Agarwal, MD Dr. Agarwal has nothing to disclose.
Christoph Stretz, MD, FAAN (Rhode Island Hospital, Department of Neurology) The institution of Dr. Stretz has received research support from American Heart Association. The institution of Dr. Stretz has received research support from Duke University Medical Center/NIH. The institution of Dr. Stretz has received research support from University of Cincinnati/NINDS.
Anson Wang, MD (Massachusetts General Hospital) Dr. Wang 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.
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.