[en] [en] BACKGROUND AND PURPOSE: Hypotension during endovascular therapy for acute ischemic stroke is associated with worse functional outcomes (FO). Given its important role in intracranial hemodynamics, we investigated whether hypotension during endovascular therapy had the same effect on FO according to the posterior communicating artery (PComA) patency.
METHODS: We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). Patients were included if they had middle cerebral artery occlusions. Primary outcome was favorable FO, defined by a modified Rankin Scale scores between 0 and 2 at 3 months.
RESULTS: One hundred forty-eight patients with middle cerebral artery occlusion were included. In patients with no PComA, an increase in minimum mean arterial pressure was positively associated with favorable FO (odds ratio per 10 mm Hg increase, 1.59 [95%CI, 1.11-2.25]; P=0.010), whereas no association was found in patients with a PComA (odds ratio, 0.77 [95% CI, 0.54-1.08]; P=0.12). Patients with no PComA and longer cumulative time with mean arterial pressure <90 mm Hg or systolic blood pressure <140 mm Hg had significantly lower rates of favorable FO, with an odds ratio per 10-minute increase of 0.75 (95% CI, 0.59-0.94; P=0.010) and 0.74 (95% CI, 0.60-0.91; P=0.003), but not in patients with a PComA.
CONCLUSIONS: Hypotension during endovascular therapy for middle cerebral artery occlusion is consistently associated with worse FO in patients with no PComA but not in those with a PComA. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02523261.
Disciplines :
Neurology
Author, co-author :
Maïer, Benjamin; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M ; Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M
Robichon, Erwan; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M
Bourcier, Romain ; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Inserm 1087, CNRS, UNIV Nantes, France
Dargazanli, Cyril ; Diagnostic and Interventional Neuroradiology Department, Gui de Chauliac Hospital, Montpellier, France (C.D
Labreuche, Julien ; Université de Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, France (J.L
Thion, Laurie-Anne; Anesthesiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (L.-A.T
Leguen, Morgan; Anesthesiology Department, Foch Hospital, France (M.L
Riem, Romuald; Anesthesiology Department, Nantes Hospital, France (R.R
Desilles, Jean-Philippe ; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M ; Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M
Boulouis, Grégoire ; Neuroradiology Department, Tours Hospital, France (G.B
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M
Hebert, Solène; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M
Redjem, Hocine; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M
Smajda, Stanislas ; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M
Escalard, Simon ; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M
Blanc, Raphaël ; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M ; Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M ; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, Inserm 1087, CNRS, UNIV Nantes (R.B
Piotin, Michel ; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M ; Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M
Lapergue, Bertrand; Stroke Center, Foch Hospital, France (B.L
Mazighi, Mikael ; Interventional Neuroradiology Department, Fondation Ophtalmologique A. de Rothschild, Paris, France (B.M., E.R., J.-P.D., F.D., S.H., H.R., S.S., S.E., R.B., M.P., M.M ; Université de Paris, France (B.M., J.-P.D., R.B., M.P., M.M
The ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization) was sponsored by the Fondation A. de Rothschild, with an unrestricted grant provided by Penumbra, Alameda, California.
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