Abstract Details

Title Association of Blood Pressure Parameters in Unsecured Aneurysmal Subarachnoid Hemorrhage and Outcomes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P14 - Poster Session 14 (11:45 AM-12:45 PM)

Poster/Presentation
Number 6-017

Objective To investigate the association between BP parameters, MAP, rebleeding events, and outcomes for aSAH patients.

Background Elevated systolic blood pressure (SBP) has been linked to pre-procedural rebleeding risk and poor outcome in patients with aneurysmal subarachnoid hemorrhage (aSAH). However, the relationship between blood pressure parameters including mean arterial pressure (MAP) with rebleeding prior to and after aneurysm securement remains unclear. This study seeks to determine the association between BP parameters and rebleeding events and outcomes in patients with aSAH.

Design/Methods We performed a retrospective analysis of consecutive patients with aSAH admitted to an academic center between 2016-2022. BP values were recorded hourly from admission. Per our institutional protocol, the SBP target is <140 mmHg for all unsecured aSAH aneurysms. Rebleeding was defined as radiographic worsening of hemorrhage prior to or immediately following aneurysm securement. Binary regression analysis was used to determine the association of maximum recorded BP with rebleeding and poor functional outcome (modified Rankin Scale [mRS] 4–6 at 3 months post-discharge).

Results The cohort included 325 patients (mean age 57 years [SD 13.4], 61% female, 87% received endovascular treatments, 13% surgical clipping). Two or more consecutive SBP values >140 were seen in 41% and >160 in 15% of patients. Rebleeding prior to or during securing aneurysms including intra-procedural bleeding occurred in 48 patients (15%). There was no association between either maximum recorded SBP (175 mmHg [36.3] vs. 167 [33.4], p=0.12) or MAP (124 mmHg [25.5] vs. 117.9 [22.5], p=0.08) and rebleeding. However, only maximum recorded MAP pre-angiogram was associated with poor outcome (OR 1.014 for 1 mmHg increase in MAP, 95% CI: 1.004–1.03, p=0.006).

Conclusions Elevated MAP peri-securement of a ruptured cerebral aneurysm can be associated with poor outcome. Multicenter prospective studies should further examine the association between MAP cut offs and outcomes to consider modifying current guidelines.

Authors/Disclosures
Ariyaporn Haripottawekul PRESENTER	Miss Haripottawekul has nothing to disclose.
	No disclosure on file
Deena A. Haque	Ms. Haque has nothing to disclose.
Elijah M. Persad-Paisley	Mr. Persad-Paisley has nothing to disclose.
Alizeh Shamshad	Ms. Shamshad has nothing to disclose.
Aiden Meyer	Mr. Meyer has received research support from Brown University - Undergraduate Teaching and Research Award.
Michael Reznik, MD (Rhode Island Hospital)	Dr. Reznik has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Morrison Mahoney. The institution of Dr. Reznik has received research support from NIDUS.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Shadi Yaghi, MD (Hackensack Meridian Health)	Dr. Yaghi has nothing to disclose.
Ali Mahta, MD (Brown University)	Dr. Mahta has received research support from Brown University Health.

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