title: Lower Intraprocedural Systolic Blood Pressure Predicts Good Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke.
abstract: BACKGROUND
  It is unknown if intraprocedural blood pressure (BP) influences clinical outcomes and what BP parameter best predicts outcomes in acute ischemic stroke (AIS) patients who undergo intra-arterial therapy (IAT) for emergent large vessel occlusion.
  
  
  METHODS
  We retrospectively reviewed 147 patients who underwent IAT for anterior circulation AIS from January 2008 to December 2012 at our institution. Baseline demographics, stroke treatment variables, and detailed intraprocedural hemodynamic variables were collected.
  
  
  RESULTS
  The entire cohort consisted of 81 (55%) females with a mean age of 66.9 ± 15.6 years and a median National Institutes of Health Stroke Scale (NIHSS) score of 16 (IQR 11-21). Thirty-six (24.5%) patients died during hospitalization, 25 (17%) achieved a 30-day modified Rankin Scale score of 0-2, and 24 (16.3%) suffered symptomatic parenchymal hematoma type 1/2 hemorrhage. Patients who achieved a good outcome had a significantly lower admission NIHSS score, a higher baseline CT ASPECTS score, and a lower rate of ICA terminus occlusions. Successful recanalization was more frequent in the good-outcome group, while symptomatic hemorrhages occurred only in poor-outcome patients. The first systolic BP (SBP; 146.5 ± 0.2 vs. 157.7 ± 25.6 mm Hg, p = 0.042), first mean arterial pressure (MAP; 98.1 ± 20.8 vs. 109.7 ± 20.3 mm Hg, p = 0.024), maximum SBP (164.6 ± 27.6 vs. 180.9 ± 18.3 mm Hg, p = 0.0003), and maximum MAP (125.5 ± 18.6 vs. 138.5 ± 24.6 mm Hg, p = 0.0309) were all significantly lower in patients who achieved good outcomes. A lower maximum intraprocedural SBP was an independent predictor of good outcome (adjusted OR 0.929, 95% CI 0.886-0.963, p = 0.0005). Initial NIHSS score was the only other independent predictor of a good outcome.
  
  
  CONCLUSIONS
  Lower intraprocedural SBP was associated with good outcome in patients undergoing IAT for AIS, and maximum SBP was an independent predictor of good outcome. SBP may be the optimal hemodynamic variable to monitor intraprocedurally during IAT and may predict outcome.
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Seby
authors.initials: S
authors.lastname: John
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Walaa
authors.initials: W
authors.lastname: Hazaa
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Gabor
authors.initials: G
authors.lastname: Toth
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bain
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Umera
authors.initials: U
authors.lastname: Thebo
authors.affiliation: Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA.
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Hussain
keywords: Acute ischemic stroke; Blood pressure; Hemodynamics; Hypertension; Intra-arterial therapy; Maximum mean arterial pressure; Maximum systolic blood pressure; Outcome