title: A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia.
abstract: BACKGROUND
  Up to two-thirds of patients are either dependent or dead 3 months after thrombectomy for acute ischemic stroke (AIS). Loss of cerebral autoregulation may render patients with AIS vulnerable to decreases in mean arterial pressure (MAP).
  
  
  OBJECTIVE
  To determine whether a fall in MAP during intervention under general anesthesia (GA) affects functional outcome.
  
  
  METHODS
  This subgroup analysis included patients from the MR CLEAN trial treated with thrombectomy under GA. The investigated variables were the difference between MAP at baseline and average MAP during GA (ΔMAP) as well as the difference between baseline MAP and the lowest MAP during GA (ΔLMAP). Their association with a shift towards better outcome on the modified Rankin Scale (mRS) after 90 days was determined using ordinal logistic regression with adjustment for prognostic baseline variables.
  
  
  RESULTS
  Sixty of the 85 patients treated under GA in MR CLEAN had sufficient anesthetic information available for the analysis. A greater ΔMAP was associated with worse outcome (adjusted common OR (acOR) 0.95 per point mm Hg, 95% CI 0.92 to 0.99). An average MAP during GA 10 mm Hg lower than baseline MAP constituted a 1.67 times lower odds of a shift towards good outcome on the mRS. For ΔLMAP this association was not significant (acOR 0.97 per mm Hg, 95% CI 0.94 to 1.00, p=0.09).
  
  
  CONCLUSIONS
  A decrease in MAP during intervention under GA compared with baseline is associated with worse outcome.
  
  
  BACKGROUND
  NTR1804; ISRCTN10888758; post-results.
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Kilian M
authors.identifier: http://orcid.org/0000-0003-3227-3620
authors.initials: KM
authors.lastname: Treurniet
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.|Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Olvert A
authors.initials: OA
authors.lastname: Berkhemer
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Rogier V
authors.initials: RV
authors.lastname: Immink
authors.affiliation: Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Vivian M C
authors.initials: VMC
authors.lastname: Ward-van der Stam
authors.affiliation: Department of Anesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Hollmann
authors.affiliation: Department of Anesthesiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Jaap
authors.initials: J
authors.lastname: Vuyk
authors.affiliation: Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Wim H
authors.identifier: http://orcid.org/0000-0003-1631-7056
authors.initials: WH
authors.lastname: van Zwam
authors.affiliation: Department of Radiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Aad
authors.identifier: http://orcid.org/0000-0002-6159-2228
authors.initials: A
authors.lastname: van der Lugt
authors.affiliation: Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Robert J
authors.identifier: http://orcid.org/0000-0003-1032-9099
authors.initials: RJ
authors.lastname: van Oostenbrugge
authors.affiliation: Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Diederik W J
authors.identifier: http://orcid.org/0000-0002-9234-3515
authors.initials: DWJ
authors.lastname: Dippel
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Coutinho
authors.affiliation: Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Yvo B W E M
authors.initials: YBWEM
authors.lastname: Roos
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.|Department of Biomedical Engineering & Physics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Henk A
authors.initials: HA
authors.lastname: Marquering
authors.affiliation: Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Charles B L M
authors.initials: CBLM
authors.lastname: Majoie
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000009:adverse effects* / Q000379:methods; D001794:Blood Pressure / Q000502:physiology*; D002545:Brain Ischemia / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000639:trends*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D020521:Stroke / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017131:Thrombectomy / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome
keywords: Blood Pressure; Stroke; Thrombectomy