blood pressure; disability; endovascular therapy; stroke; thrombectomy; Humans; Blood Pressure; Cerebral Hemorrhage/complications; Magnetic Resonance Imaging; Patient Acuity; Brain Ischemia/complications; Cerebral Small Vessel Diseases/complications; Cerebral Small Vessel Diseases/diagnostic imaging; Cerebral Small Vessel Diseases/epidemiology; Endovascular Procedures; Stroke/diagnostic imaging; Stroke/drug therapy; Stroke/complications; Brain Ischemia; Cerebral Hemorrhage; Cerebral Small Vessel Diseases; Neurology; Neurology (clinical)
Abstract :
[en] [en] BACKGROUND AND PURPOSE: Acute ischaemic stroke patients with cerebral small vessel disease (CSVD), including cerebral microbleeds (CMBs) and white matter hyperintensities (WMHs), have worse outcomes. The effect was investigated of two blood pressure strategies (intensive vs. standard) and blood pressure variability (BPV) after reperfusion according to CSVD burden in the BP TARGET trial.
METHODS: Patients with available magnetic resonance imaging at baseline were included. CMBs were described as absent or present and WMH severity was described according to the Fazekas classification (0-1, absent-mild; 2-3, moderate to severe). Outcomes consisted of any intracerebral hemorrhage (ICH) at 24 h and favorable outcome at 90 days (modified Rankin Scale score between 0 and 2).
RESULTS: In all, 246 patients were included. The intensive systolic blood pressure target was not associated with lower rates of ICH or favorable outcome according to CSVD subgroups (all p values >0.35). Several BPV parameters were associated with increased odds of ICH in patients with CMBs but not in patients without CMBs (diastolic blood pressure coefficient of variation, odds ratio 2.06, 95% confidence interval [CI] 1.13-3.77, in patients with ≥1 CMB vs. 0.94, 95% CI 0.68-1.31, in patients without CMBs, phet = 0.026). Several diastolic BPV parameters were associated with worse outcomes in patients with severe WMHs but not in patients without WMHs (diastolic blood pressure coefficient of variation, odds ratio 0.32, 95% CI 0.17-0.61, in patients with severe WMHs vs. 1.09, 95% CI 0.67-1.79, in patients without WMHs; phet = 0.003).
CONCLUSION: No effect of the intensive systolic blood pressure management strategy was found on ICH occurrence or functional outcome according to CSVD burden. BPV was associated with higher odds of ICH in patients with CMBs and worse outcome in patients with moderate-to-severe WMHs.
Disciplines :
Neurology
Author, co-author :
Brauner, Ran; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ; Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
Gory, Benjamin ; Department of Diagnostic and Therapeutic Neuroradiology, Université de Lorraine, CHRU-Nancy, Nancy, France ; Université de Lorraine, IADI, INSERM U1254, Nancy, France
Lapergue, Bertrand; Division of Neurology, Department of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France
Sibon, Igor ; Stroke Unit, CHU Bordeaux, Université de Bordeaux, Bordeaux, France
Richard, Sebastien; Department of Neurology, Université de Lorraine, CHRU-Nancy, Nancy, France
Kyheng, Maeva; Department of Biostatistics, CHU Lille, Lille, France
Labreuche, Julien; Department of Biostatistics, CHU Lille, Lille, France
Desilles, Jean-Philippe; Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France ; Université de Paris Cité, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Blanc, Raphael; Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Piotin, Michel; Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Halimi, Jean-Michel; Nephrology Department, Tours Hospital, Tours, France ; Université de Tours, Tours, France ; EA4245-Transplantation, Immunology and Inflammation, University of Tours, Tours, France
Mazighi, Mikael; Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France ; Université de Paris Cité, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France ; Department of Neurology, Hopital Lariboisière, APHP Nord, Paris, France
Maïer, Benjamin; Interventional Neuroradiology Department, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France ; Université de Paris Cité, Paris, France ; FHU NeuroVasc, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France ; Neurology and Neurovascular Departments, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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