Lu You, Shen Rui, Lin Wenjian, Zhou Xiaoyu, Hu Jian, Zhang Quanbin
Department of Neurology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Department of Neurosurgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Front Neurol. 2022 Aug 10;13:967395. doi: 10.3389/fneur.2022.967395. eCollection 2022.
Nearly half of patients who undergo mechanical thrombectomy (MT) do not experience a favorable outcome. The association between blood pressure fluctuation and clinical outcomes after successful MT is controversial. We evaluated the influence of blood pressure variability (BPV) on the clinical outcomes of stroke patients with large vessel occlusion (LVO) who underwent successful recanalization after MT.
Patients with anterior circulation LVO stroke who underwent successful emergency MT (modified Thrombolysis in Cerebral Infarction, mTICI ≥ 2b) at the Shanghai Tenth People's Hospital of Tongji University from 2017 to 2021 were enrolled. Multivariate logistic models were used to investigate the association between BPV (mean arterial pressure [MAP] assessed using the standard deviation [SD]) and clinical outcomes. The primary outcome was 90-day modified Rankin Scale scores (mRS), and the secondary outcomes were 30-day mortality and symptomatic intracranial hemorrhage (sICH).
A total of 458 patients (56.8% men), with a mean age of 72 ± 1 years, were enrolled. Among them, 207 (45.2%) patients had unfavorable functional outcomes (mRS score 3-6) at 90 days, 61 (13.3%) patients died within 30 days, and 20 (4.4%) patients had sICH. In a fully adjusted model, BPV was associated with a higher risk of a 90-day mRS score of 3-6 ( = 0.04), 30-day mortality ( < 0.01), and sICH ( < 0.01). A significant interaction between MAP SD and rescue futile recanalization treatment was observed ( < 0.01).
Among patients with LVO stroke who underwent successful recanalization, higher BPV was associated with worse functional outcomes, especially in those who underwent rescue treatment.
接受机械取栓术（MT）的患者中近一半未获得良好预后。成功MT后血压波动与临床结局之间的关联存在争议。我们评估了血压变异性（BPV）对大动脉闭塞（LVO）性卒中患者成功再通后MT临床结局的影响。
纳入2017年至2021年在同济大学附属上海市第十人民医院接受成功急诊MT（改良脑梗死溶栓，mTICI≥2b）的前循环LVO性卒中患者。采用多变量逻辑模型研究BPV（使用标准差[SD]评估的平均动脉压[MAP]）与临床结局之间的关联。主要结局为90天改良Rankin量表评分（mRS），次要结局为30天死亡率和症状性颅内出血（sICH）。
共纳入458例患者（男性占56.8%），平均年龄为72±1岁。其中，207例（45.2%）患者在90天时功能结局不佳（mRS评分3 - 6），61例（13.3%）患者在30天内死亡，20例（4.4%）患者发生sICH。在完全调整模型中，BPV与90天mRS评分3 - 6的较高风险（ = 0.04）、30天死亡率（ < 0.01）和sICH（ < 0.01）相关。观察到MAP标准差与挽救性无效再通治疗之间存在显著交互作用（ < 0.01）。
在成功再通的LVO性卒中患者中，较高的BPV与较差的功能结局相关，尤其是在接受挽救治疗的患者中。
