Department of Neurology, Krajska zdravotni as Masarykova nemocnice v Usti nad Labem oz, Usti nad Labem, Czech Republic.
Department of Neurology, Univ Hosp Olomouc, Olomouc, Czech Republic.
J Neurointerv Surg. 2019 Aug;11(8):735-739. doi: 10.1136/neurintsurg-2018-014548. Epub 2019 Feb 6.
Despite early management and technical success of mechanical thrombectomy (MT) for acute ischemic stroke (AIS), not all patients reach a good clinical outcome. Different factors may have an impact and we aimed to evaluate blood pressure (BP) levels in the first 24 hours after MT.
Consecutive AIS patients treated with MT were enrolled in the retrospective bi-center study. Neurological deficit was assessed with National Institutes of Health Stroke Scale (NIHSS) and functional outcome after 3 months with modified Rankin scale (mRS) with a score 0-2 for good outcome. The presence of symptomatic intracerebral hemorrhage (SICH) was assessed according to the SITS-MOST criteria.
Of 703 treated patients, completed BP levels were collected in 690 patients (350 males, mean age 71±13 years) with median of admission NIHSS 17 points. Patients with mRS 0-2 had a lower median of systolic BP (SBP) compared with those with poor outcome (131 vs 140 mm Hg, P<0.0001). The rate of SICH did not differ between the patients with a median of SBP <140 mm Hg and ≥140 mm Hg. (5.1% vs 5.1%, P=0.980). Multivariate regression analysis with adjustment for potential confounders showed a median of distolic BP (P=0.024, OR: 0.977, 95% CI: 0.957 to 0.997) as a predictor of good functional outcome after MT, and a median of maximal SBP (P=0.038; OR: 0.990, 95% CI: 0.981 to 0.999) in the patients with achieved recanalization.
Lowering of BP within the first 24 hours after MT may have a positive impact on clinical outcome in treated patients.
尽管急性缺血性脑卒中（AIS）的机械取栓（MT）在早期管理和技术上取得了成功，但并非所有患者都能达到良好的临床转归。不同的因素可能会产生影响，我们旨在评估 MT 后 24 小时内的血压（BP）水平。
连续纳入接受 MT 治疗的 AIS 患者进行回顾性的双中心研究。采用国立卫生研究院卒中量表（NIHSS）评估神经功能缺损，采用改良 Rankin 量表（mRS）评估 3 个月时的功能结局，mRS 评分为 0-2 分表示预后良好。根据 SITS-MOST 标准评估症状性颅内出血（SICH）的发生情况。
在 703 例接受治疗的患者中，有 690 例（350 例男性，平均年龄 71±13 岁）患者的完整 BP 数据可用于分析，入院时 NIHSS 的中位数为 17 分。mRS 评分为 0-2 的患者的收缩压（SBP）中位数低于预后不良的患者（131 对 140mmHg，P<0.0001）。SBP 中位数<140mmHg 和≥140mmHg 的患者 SICH 发生率无差异（5.1%对 5.1%，P=0.980）。多变量回归分析校正潜在混杂因素后显示，舒张期 BP 中位数（P=0.024，OR：0.977，95%CI：0.957 至 0.997）是 MT 后良好功能结局的预测因素，且达到再通的患者 SBP 最大值的中位数（P=0.038；OR：0.990，95%CI：0.981 至 0.999）也是预测因素。
MT 后 24 小时内降低 BP 可能对治疗患者的临床转归产生积极影响。
