Department of Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
Penn State Hershey Comprehensive Stroke Center, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
World Neurosurg. 2021 Apr;148:e635-e642. doi: 10.1016/j.wneu.2021.01.052. Epub 2021 Jan 23.
Variability, with no general consensus, exists in how patients' blood pressure should be managed after successful mechanical thrombectomy (MT) for large vessel ischemic stroke. We examined whether exceeding the systolic blood pressure (SBP) targets in patients during the first 24 hours after successful MT led to worse outcomes.
We retrospectively studied a consecutive sample of adult patients who had undergone MT. We collected SBP data for the first 24 hours after MT and categorized the patients into 3 groups according to cases of the SBP exceeding 140, 160, or 180 mm Hg. The primary and secondary outcomes were the modified Rankin scale score at discharge and 90 days of follow-up, the incidence of symptomatic intracranial hemorrhage, malignant cerebral edema, and hemicraniectomy, mortality within 90 days, and discharge disposition.
A total of 117 patients were included (mean age, 65 ± 13.12 years; 53% female). The occurrence of ≥1 instance of SBP ≥180 mm Hg was significantly associated with poor functional outcomes at discharge (adjusted odds ratio [OR], 5.83; 95% confidence interval [CI], 1.41-32.9; P = 0.025) but not at 90 days of follow-up. The occurrence of SBP ≥160 mm Hg resulted in an independently increased odds of malignant cerebral edema (adjusted OR, 17.07; 95% CI, 2.56-174.4; P = 0.01), with a trend toward increased odds of symptomatic intracranial hemorrhage (adjusted OR, 4.42; 95% CI, 1.03-21.2; P = 0.0503).
These results suggest that individual instances of SBP elevation alone after successful MT, rather than a necessarily prolonged increased blood pressure as reflected by the mean or median SBP values, can significantly affect the clinical outcomes after successful MT.
成功进行机械取栓（MT）治疗大动脉缺血性脑卒中后，患者血压的管理方式存在差异，尚无共识。我们研究了在 MT 后 24 小时内患者的收缩压（SBP）超过目标值是否会导致预后更差。
我们回顾性研究了连续接受 MT 的成年患者样本。我们收集了 MT 后 24 小时内的 SBP 数据，并根据 SBP 超过 140、160 或 180mmHg 的情况将患者分为 3 组。主要和次要结局是出院时和 90 天随访时的改良 Rankin 量表评分、症状性颅内出血、恶性脑肿胀和去骨瓣减压的发生率、90 天内死亡率和出院去向。
共纳入 117 例患者（平均年龄 65±13.12 岁，53%为女性）。SBP≥180mmHg 出现≥1 次与出院时功能结局不良显著相关（校正比值比[OR]，5.83；95%置信区间[CI]，1.41-32.9；P=0.025），但与 90 天随访时无关。SBP≥160mmHg 与恶性脑肿胀的独立发生风险增加相关（校正 OR，17.07；95%CI，2.56-174.4；P=0.01），且症状性颅内出血的发生风险呈增加趋势（校正 OR，4.42；95%CI，1.03-21.2；P=0.0503）。
这些结果表明，MT 后单独出现的 SBP 升高，而不是平均或中位数 SBP 值所反映的血压持续升高，可能显著影响 MT 后患者的临床结局。
