Department of Neurosurgery, University of Miami, Miami, USA.
University of Miami Miller School of Medicine, 1095 N.W. 14th Terrace, 2nd Floor (D4-6), Miami, FL, 33136, USA.
Neurocrit Care. 2020 Feb;32(1):198-205. doi: 10.1007/s12028-019-00803-7.
Most data evaluating the relationship of post-mechanical thrombectomy (MT) blood pressure (BP) management and outcomes of patients with large vessel occlusion (LVO) focus on early BP control within the first 24 h. We investigated the correlation of daily BP trends up to the third day following MT with patient outcomes.
We retrospectively reviewed our prospectively maintained database for LVO patients treated with MT from February 2015 to December 2017. Recorded BP values for 72 h post-reperfusion were reviewed. Daily peak systolic and diastolic blood pressures (SBP, DBP) were extracted for each day post-procedure. The association and importance between BP increments of 10 mmHg and mortality, hemorrhage, and functional independence (FI = mRS ≤ 2) was analyzed in a multivariable logistic regression and random forest (RF) analyses modeling.
A total of 212 thrombectomies were included. An increase in peak 24-h SBP was independently associated with higher likelihood of symptomatic hemorrhage (OR 1.2, p = 0.048) and decreased functional independence (OR 0.85, p = 0.03). Higher day 2 and day 3 peak SBP was strongly correlated with decreased functional independence and higher mortality. Third day SBP < 140 was independently associated with higher likelihood of functional independence (OR 4.3, p = 0.0004). Post-MT patients with and without functional independence demonstrated a similar relative decrease in peak SBP between the first 2 days following thrombectomy (p = 0.26); however, those without functional independence experienced a significant rebound increase in peak SBP on the third day following MT (mean change from day 2 to 3: FI - 3.5 mmHg, non-FI + 3.9 mmHg; p = 0.005).
High daily maximum SBP and a rebound SBP on the third day following MT is independently associated with increased likelihood of functional dependence.
大多数评估机械血栓切除术后（MT）血压（BP）管理与大血管闭塞（LVO）患者结局之间关系的数据都集中在 24 小时内的早期 BP 控制。我们研究了 MT 后第三天内每日 BP 趋势与患者结局的相关性。
我们回顾性分析了 2015 年 2 月至 2017 年 12 月期间接受 MT 治疗的 LVO 患者的前瞻性维护数据库。回顾再灌注后 72 小时内的 BP 值。提取每天的收缩压（SBP）和舒张压（DBP）的日峰值。采用多变量逻辑回归和随机森林（RF）分析模型分析 10mmHg 的 BP 增量与死亡率、出血和功能独立性（FI= mRS≤2）之间的相关性和重要性。
共纳入 212 例次 MT。24 小时 SBP 峰值升高与症状性出血（OR 1.2，p=0.048）和功能独立性降低（OR 0.85，p=0.03）的可能性增加独立相关。第 2 天和第 3 天的 SBP 峰值升高与功能独立性降低和死亡率升高密切相关。第 3 天 SBP<140mmHg 与功能独立性增加的可能性独立相关（OR 4.3，p=0.0004）。具有和不具有功能独立性的 MT 后患者在 MT 后第 1 天至第 2 天之间 SBP 峰值的相对降低相似（p=0.26）；然而，那些没有功能独立性的患者在 MT 后第 3 天的 SBP 峰值出现显著反弹（从第 2 天到第 3 天的平均变化：FI-3.5mmHg，非 FI+3.9mmHg；p=0.005）。
MT 后第三天的高日最大 SBP 和 SBP 反弹与功能依赖性增加独立相关。
