Carvalho Dias Mariana, Gabriel Denis, Saraiva Marlene, Campos Daniel, Requena Manuel, García-Tornel Álvaro, Muchada Marian, Boned Sandra, Rodriguez-Luna David, Rodriguez-Villatoro Noelia, Pagola Jorge, Juega Jesus, Deck Matías, Ribo Marc, Tomasello Alejandro, Molina Carlos A, Rubiera Marta
Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
Neurology Department, Hospital de Santo António, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Eur Stroke J. 2020 Dec;5(4):362-369. doi: 10.1177/2396987320933384. Epub 2020 Jun 11.
Spontaneous blood pressure drop within the first 24 h has been reported following arterial recanalisation in ischaemic stroke patients. We aimed to assess if spontaneous blood pressure drop within the first hour after mechanical thrombectomy is a marker of early neurological recovery.
Retrospective observational single-centre study including ischaemic stroke patients treated with mechanical thrombectomy. Blood pressure parameters from admission, mechanical thrombectomy start, mechanical thrombectomy end and hourly within 24 h after mechanical thrombectomy were reviewed. Primary outcome was early dramatic neurological recovery (8-point-reduction in NIHSS or NIHSS ≤ 2 at 24 h). Secondary outcome was functional independence at 90 days (mRankin 0-2).
We included 458 patients in our analysis. Two-hundred (43.7%) patients achieved dramatic neurological recovery following mechanical thrombectomy. One hour after mechanical thrombectomy end, median systolic blood pressure was significantly different between outcome groups (129 vs. 138 mmHg, = 0.005) and a higher drop in median systolic blood pressure was seen in the dramatic neurological recovery group (15 vs. 9 mmHg). Optimal cut-off for predicting dramatic neurological recovery was a systolic blood pressure drop of 10.5 mmHg (sensitivity 0.54, specificity 0.55, AUC 0.55). On multivariate analysis, spontaneous systolic blood pressure drop was associated with higher odds of achieving dramatic neurological recovery (OR for 10 mmHg blood pressure drop 1.14, 95% CI 1.01-1.29, = 0.04). No significative association between any blood pressure parameter drop and functional independence at 90 days was found.
We hypothesised that spontaneous systolic blood pressure drop is a marker of successful reperfusion and, therefore, a marker of improvement of cerebral autoregulation due to the reduced final ischaemic core.
Spontaneous systolic blood pressure drop after mechanical thrombectomy is an early predictor of dramatic neurological recovery.
有报道称，缺血性中风患者动脉再通后24小时内会出现自发性血压下降。我们旨在评估机械取栓术后第一小时内的自发性血压下降是否为早期神经功能恢复的标志物。
一项回顾性观察性单中心研究，纳入接受机械取栓治疗的缺血性中风患者。回顾了入院时、机械取栓开始时、机械取栓结束时以及机械取栓后24小时内每小时的血压参数。主要结局是早期显著神经功能恢复（美国国立卫生研究院卒中量表[NIHSS]评分降低8分或24小时时NIHSS≤2分）。次要结局是90天时的功能独立性（改良Rankin量表评分0 - 2分）。
我们纳入了458例患者进行分析。200例（43.7%）患者在机械取栓后实现了显著神经功能恢复。机械取栓结束后1小时，结局组之间的收缩压中位数有显著差异（129 vs. 138 mmHg，P = 0.005），且在显著神经功能恢复组中收缩压中位数下降幅度更大（15 vs. 9 mmHg）。预测显著神经功能恢复的最佳截断值为收缩压下降10.5 mmHg（敏感性0.54，特异性0.55，曲线下面积0.55）。多因素分析显示，自发性收缩压下降与实现显著神经功能恢复的较高几率相关（收缩压下降10 mmHg的比值比为1.14，95%置信区间1.01 - 1.29，P = 0.04）。未发现任何血压参数下降与90天时的功能独立性之间存在显著关联。
我们假设自发性收缩压下降是成功再灌注的标志物，因此也是由于最终缺血核心缩小导致脑自动调节改善的标志物。
机械取栓后自发性收缩压下降是显著神经功能恢复的早期预测指标。
