Department of Neurology (S.A.v.d.B., J.M.C., Y.B.W.E.M.R., P.J.N.), Amsterdam University Medical Center, University of Amsterdam, the Netherlands.
Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, the Netherlands (S.M.U.V., H.B.v.d.W.).
Stroke. 2020 Nov;51(11):3205-3214. doi: 10.1161/STROKEAHA.120.029907. Epub 2020 Oct 12.
Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT.
We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP.
We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04-1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03-1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94-0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99-1.13]). Results for DBP were largely similar.
In patients with acute ischemic stroke treated with EVT, higher admission BP is associated with lower probability of successful reperfusion and with poor clinical outcomes. Further research is needed to investigate whether these patients benefit from BP reduction before EVT.
急性缺血性脑卒中血管内治疗前的最佳血压（BP）目标尚不清楚。我们旨在评估入院 BP 与血管内治疗后临床结局和再灌注成功之间的关系。
我们使用了来自 MR CLEAN（荷兰多中心急性缺血性脑卒中血管内治疗随机对照试验）登记处的数据，这是一项在荷兰常规临床实践中对接受血管内治疗的缺血性脑卒中患者进行的观察性、前瞻性、全国性队列研究。入院时记录基础收缩压（SBP）和舒张压（DBP）。主要结局为 90 天改良 Rankin 量表评分。次要结局包括再灌注成功（扩展脑梗死溶栓评分 2B-3）、症状性颅内出血和 90 天死亡率。多变量逻辑和线性回归用于评估 SBP 和 DBP 与结局的关系。测试了 BP 与结局之间的非线性关系。根据 BP 每增加或减少 10mmHg 计算参数估计值。
我们纳入了 2014 年 3 月至 2017 年 11 月间接受血管内治疗的 3180 例患者。入院 SBP 和 DBP 与 90 天改良 Rankin 量表评分和死亡率的关系呈 J 型，拐点分别约为 150mmHg 和 81mmHg。SBP 高于 150mmHg 与功能不良结局（校正后的共同优势比，1.09[95%CI，1.04-1.15]）和 90 天死亡率（校正后的优势比，1.09[95%CI，1.03-1.16]）相关。在呈线性关系的情况下，较高的 SBP 与再灌注成功的可能性降低相关（校正后的优势比，0.97[95%CI，0.94-0.99]），与症状性颅内出血的发生相关（校正后的优势比，1.06[95%CI，0.99-1.13]）。DBP 的结果基本相似。
在接受血管内治疗的急性缺血性脑卒中患者中，较高的入院 BP 与再灌注成功的可能性降低以及较差的临床结局相关。需要进一步研究以探讨这些患者是否受益于血管内治疗前的 BP 降低。
