Abstract Details

Title Elevated Pre-hospital Blood Pressure is Associated with Reduced Infarct Volume in Large Vessel Occlusion Ischemic Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-016

Objective This study evaluated the impact of pre-hospital blood pressure (BP) on infarct volume and perfusion parameters, in large vessel occlusion acute ischemic stroke (LVO-AIS) patients undergoing mechanical thrombectomy (MT).

Background Following a LVO-AIS there is an important disruption in cerebral autoregulation (CA), making optimal BP critical to maintain adequate cerebral perfusion. While prior research links intraprocedural BP drops and high post-thrombectomy BP to poor outcomes, data on pre-hospital hemodynamics remain limited.

Design/Methods This retrospective observational study included data of LVO-AIS patients from two comprehensive stroke centers from 01-2018 to 12-2021. Inclusion criteria: >18 years, anterior circulation LVO, and >3 pre-hospital BP recordings. BP was measured non-invasively, and mean SBP(mSBP) and MAP(mMAP) were calculated. Collateral status was evaluated via hypoperfusion intensity ratio (HIR, Tmax 10s/Tmax 6s). The main outcome was initial infarct volume (IIV, defined as admission rCBF<30% on CTP). Other outcomes included mismatch volume and ratio, early infarct growth ratio (EIGR, rCBF<30%/stroke onset to CTP time). We used multivariable linear regression, interaction, and subgroup analysis.

Results 171 patients were included. Initial CTP paremeters included: median IIV of 6cc, Tmax>6s of 103cc, Tmax>10s , and HIR 0.38. We found that for each unit increase in mMAP, IIV decreased by 10%(adjusted coefficient [aCoeff] 0.90, p<0.001), and the EIGR decreased in 9%(aCoeff. 0.91, p<0.001). For each unit increase in mSBP, mismatch volume increased in 3% (aCoeff. 1.03, p=0.021) and EIGR decreased in 3% (aCoeff. 0.97, p=0.035). In subgroup analysis, the association between higher BP and lower IIV persisted exclusively in patients with good collaterals.

Conclusions Elevated pre-hospital BP wwas associated with reduced IIV, increased mismatch volume, and slower infarct growth, primarily in patients with good collateral status. These findings underscore the need for prospective studies to better evaluate the optimal BP thresholds in the pre-hospital settings and the role of collateral status in influencing stroke outcomes.

Authors/Disclosures
Milagros Galecio-Castillo, MD PRESENTER	Dr. Galecio-Castillo has nothing to disclose.
Sophie L. Shogren, MD (University of Iowa Hospitals and Clinics)	Dr. Shogren has nothing to disclose.
Madelynne Olexa	Miss Olexa has nothing to disclose.
Yelyzaveta Begunova	Miss Begunova has nothing to disclose.
Leonardo Cruz, MD (University of Iowa)	Dr. Cruz has nothing to disclose.
Piyush Kalakoti, MBBS	Dr. Kalakoti has nothing to disclose.
Anderson Brito-Alvarado, MD	Dr. Brito-Alvarado has nothing to disclose.
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.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.

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