Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment.
OBJECTIVE
High admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). We sought to evaluate the association of admission BP with early outcomes in patients with ELVO treated with EVT.


METHODS
Consecutive patients with AIS presenting with ELVO in a tertiary stroke center during a 4-year period were prospectively evaluated. Admission systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated cuff recordings. A blinded neuroradiologist calculated the final infarct volume (FIV) using standardized ABC/2 methodology. A favorable functional outcome (FFO) at 3 months was defined as modified Rankin Scale score of 0-2.


RESULTS
Our study population consisted of 116 patients with AIS (mean age 63±13 years, median NIH Stroke Scale score 17 points (IQR 14-21), median FIV 30 cm3(IQR 8-94)). Higher admission SBP correlated with higher FIV (r +0.225; p=0.020). Patients with FFO had lower admission SBP (151±24 mm Hg vs 165±28 mm Hg; p=0.010), while admission SBP levels were higher in patients who died during hospitalization (169±34 mm Hg vs 156±24 mm Hg; p=0.043). A 10 mm Hg increment in admission SBP was independently (p=0.010) associated with an increase of 12 cm3in FIV (95% CI 3 to 21) in multiple linear regression models adjusting for potential confounders. A 10 mm Hg increment in admission SBP was independently (p=0.012) associated with a lower likelihood of FFO at 3 months (OR 0.64; 95% CI 0.45 to 0.91) in multiple logistic regression models adjusting for potential confounders.


CONCLUSIONS
Higher admission SBP is an independent predictor of increased FIV and lower likelihood of 3-month FFO in patients with ELVO treated with EVT.
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Nitin
N
Goyal
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.|Second Department of Neurology, "Attikon University Hospital", School of Medicine, University of Athens, Athens, Greece.|International Clinical Research Center, St. Anne's Hospital, Brno, Czech Republic.
Georgios
G
Tsivgoulis
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Sulaiman
S
Iftikhar
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Yasser
Y
Khorchid
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Muhammad
M
Fawad Ishfaq
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.|Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Vinodh T
VT
Doss
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Ramin
R
Zand
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Jason
J
Chang
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Khalid
K
Alsherbini
Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Asim
A
Choudhri
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Daniel
D
Hoit
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Andrei V
AV
Alexandrov
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Adam S
AS
Arthur
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.|Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Lucas
L
Elijovich
D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000175:diagnosis / Q000601:surgery*; D057510:Endovascular Procedures / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000639:trends*; D011446:Prospective Studies; D016037:Single-Blind Method; D020521:Stroke / Q000175:diagnosis / Q000601:surgery*; D062606:Tertiary Care Centers / Q000639:trends; D016896:Treatment Outcome
Blood Pressure; Stroke; Thrombolysis