[en] [en] BACKGROUND AND PURPOSE: To assess the association between systolic blood pressure change (ΔSBP) at different time intervals after successful reperfusion with radiographic and clinical outcomes.
METHODS: This is a post hoc analysis of the BP-TARGET multicenter trial (Blood Pressure Target in Acute Stroke to Reduce Hemorrhage After Endovascular Therapy). ΔSBP was defined as end of procedure SBP minus mean SBP at different time intervals (15-60 minutes, 1-6 hours, and 6-24 hours postprocedure). The primary outcome was the poor functional outcome (90-day modified Rankin Scale score 3-6).
RESULTS: We included a total of 267 patients (130 in the intensive treatment group). Compared with patients with favorable outcome, patients with poor outcome had lower ΔSBP (less SBP reduction) at all times intervals. After adjusting for potential confounders including baseline SBP, both ΔSBP15-60M and ΔSBP6-24H were associated with lower odds of poor outcome (adjusted odds ratio per 5 mm Hg SBP reduction, 0.89 [95% CI, 0.81-0.99], and adjusted odds ratio 0.82 [95% CI, 0.73-0.92], respectively). Concerning safety outcomes, patients with intraparenchymal hemorrhage had lower ΔSBP at all time intervals. ΔSBP15-60M was associated with lower odds of any intraparenchymal hemorrhage (adjusted odds ratio per 5 mm Hg SBP reduction 0.91 [95% CI, 0.83-0.99]). Conversely, ΔSBP was not associated with mortality or neurological deterioration at any time interval.
CONCLUSIONS: After successful reperfusion, ΔSBP had a linear relationship with poor outcome and the risk of poor outcome was higher with less reduction from the baseline SBP. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03160677.
Disciplines :
Neurology
Author, co-author :
Anadani, Mohammad ; Department of Neurology, Washington University, St Louis, MO (M.A ; Department of Neurosurgery, Medical University of South Carolina, Charleston (M.A
Maïer, Benjamin ; Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M ; University of Paris, France (B.M., J.-P.D., M.M ; FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M
Escalard, Simon ; Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M
Labreuche, Julien ; University of Lille, CHU Lille, ULR 2694-METRICS: Évaluation des technologies de santé et des pratiques médicales, France (J.L ; CHU Lille, Department of Biostatistics, France (J.L
de Havenon, Adam ; Department of Neurology, University of Utah, Salt Lake City (A.d.H
Sabben, Candice
Lapergue, Bertrand; Division of Neurology, Department of Neurology, Stroke Centre, Foch Hospital, University Versailles Saint-Quentin en Yvelines, Suresnes, France (B.L
Gory, Benjamin ; Department of Diagnostic and Therapeutic Neuroradiology, Nancy, France (B.G ; Université de Lorraine, IADI, INSERM U1254, Nancy, France (B.G
Richard, Sebastien
Sibon, Igor
Desilles, Jean-Philippe ; University of Paris, France (B.M., J.-P.D., M.M ; FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M
Piotin, Michel ; FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M
Mazighi, Mikael ; Department of Interventional Neuroradiology, Hôpital Fondation Ophtalmologique Adolphe de Rothschild, Paris, France (B.M., S.E., J.-P.D., R.B., M.P., M.M ; University of Paris, France (B.M., J.-P.D., M.M ; FHU Neurovasc, Paris, France (B.M., J.-P.D., R.B., M.P., M.M
This work was funded by the French health Ministry, PHRC-IR, AOR16037; BP-TARGET: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03160677.
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