Association of blood pressure and outcomes differs upon cerebral perfusion post-thrombectomy in patients with acute ischemic stroke

Jinjie Liu; Ximing Nie; Zhe Zhang; Wanying Duan; Xin Liu; Hongyi Yan; Lina Zheng; Changgeng Fang; Jiaping Chen; Yuyi Wang; Zhixuan Wen; Shuning Cai; Miao Wen; Zhonghua Yang; Yuesong Pan; Sibo Liu; Liping Liu

doi:10.1136/jnis-2024-021487

Association of blood pressure and outcomes differs upon cerebral perfusion post-thrombectomy in patients with acute ischemic stroke

J Neurointerv Surg. 2024 May 2:jnis-2024-021487. doi: 10.1136/jnis-2024-021487. Online ahead of print.

Authors

Jinjie Liu¹, Ximing Nie^{1

2}, Zhe Zhang^{1

2}, Wanying Duan^{1

2}, Xin Liu^{1

2}, Hongyi Yan^{1

2}, Lina Zheng^{1

2}, Changgeng Fang^{1

2}, Jiaping Chen^{1

2}, Yuyi Wang^{1

2}, Zhixuan Wen^{1

2}, Shuning Cai^{1

2}, Miao Wen^{1

2}, Zhonghua Yang^{1

2}, Yuesong Pan^{1

2}, Sibo Liu³, Liping Liu^{4

2}

Affiliations

¹ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² China National Clinical Research Center for Neurological Diseases, Beijing, China.
³ Surgical Intensive Care Unit, Dalian University of Technology Affiliated Central Hospital (Dalian Central Hospital), Dalian, Liaoning, China.
⁴ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China lipingsister@gmail.com.

PMID: 38697808
DOI: 10.1136/jnis-2024-021487

Abstract

Background: The relationship between post-endovascular thrombectomy (EVT) blood pressure (BP) and outcomes in patients with acute ischemic stroke (AIS) remains contentious. We aimed to explore whether this association differs with different cerebral perfusion statuses post-EVT.

Methods: In a multicenter observational study of patients with AIS with large vessel occlusion who underwent EVT, we enrolled those who accepted CT perfusion (CTP) imaging within 24 hours post-EVT. We recorded post-EVT systolic (SBP) and diastolic BP. Patients were stratified into favorable perfusion and unfavorable perfusion groups based on the hypoperfusion intensity ratio (HIR) on CTP. The primary outcome was good functional outcome (90-day modified Rankin Scale score of ≤3). Secondary outcomes included early neurological deterioration, infarct size growth, and symptomatic intracranial hemorrhage.

Results: Of the 415 patients studied (mean age 62 years, 75% male), 233 (56%) achieved good functional outcomes. Logistic regression showed that post-EVT HIR and 24-hour mean SBP were significantly associated with functional outcomes. Among the 326 (79%) patients with favorable perfusion, SBP <140 mmHg was associated with a higher percentage of good functional outcomes compared with SBP ≥140 mmHg (68% vs 52%; aOR 1.70 (95% CI 1.00 to 2.89), P=0.04). However, no significant difference was observed between SBP and functional outcomes in the unfavorable perfusion group. There was also no discernible difference between SBP and secondary outcomes across the different perfusion groups.

Conclusions: In patients with favorable perfusion post-EVT, SBP <140 mmHg was associated with good functional outcomes, which underscores the need for further investigations with larger sample sizes or a more individualized BP management strategy.

Clinical trial registration: ChiCTR1900022154.

Keywords: Blood Pressure; CT perfusion; Stroke; Thrombectomy.