Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
J Neurointerv Surg. 2018 Feb;10(2):107-111. doi: 10.1136/neurintsurg-2017-012988. Epub 2017 Apr 12.
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).
To determine whether a fall in MAP during intervention under general anesthesia (GA) affects functional outcome.
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.
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).
A decrease in MAP during intervention under GA compared with baseline is associated with worse outcome.
NTR1804; ISRCTN10888758; post-results.
在接受急性缺血性脑卒中（AIS）取栓治疗后，多达三分之二的患者在 3 个月时出现依赖或死亡。脑自动调节功能的丧失可能使 AIS 患者易受平均动脉压（MAP）下降的影响。
确定全身麻醉（GA）下介入过程中 MAP 的下降是否会影响功能预后。
本亚组分析纳入了在 GA 下接受取栓治疗的 MR CLEAN 试验患者。研究变量包括 MAP 在基线时与 GA 期间平均 MAP 之间的差值（ΔMAP）以及基线 MAP 与 GA 期间最低 MAP 之间的差值（ΔLMAP）。使用有序逻辑回归，在调整预后基线变量后，确定这些变量与 90 天后改良 Rankin 量表（mRS）向更好方向转变的相关性。
在 MR CLEAN 中，接受 GA 治疗的 85 例患者中有 60 例有足够的麻醉信息可供分析。ΔMAP 越大，结果越差（调整后常见比值比（acOR）为每点 mm Hg 0.95，95%置信区间为 0.92 至 0.99）。GA 期间的平均 MAP 比基线 MAP 低 10mmHg，mRS 向良好结局转变的可能性降低 1.67 倍。对于 ΔLMAP，这种相关性不显著（acOR 为每 mm Hg 0.97，95%CI 为 0.94 至 1.00，p=0.09）。
与基线相比，GA 下介入过程中 MAP 的下降与预后不良相关。
NTR1804；ISRCTN10888758；post-results。
