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血压与血管内治疗结局的关系因基线灌注和再灌注状态而异。

Association between blood pressure and endovascular treatment outcomes differs by baseline perfusion and reperfusion status.

机构信息

Department of Neurology, Seoul National University Bundang Hospital, Office #8710, 82 Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.

Cerebrovascular Center, Gyeonggi Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.

出版信息

Sci Rep. 2023 Aug 23;13(1):13776. doi: 10.1038/s41598-023-40572-0.

DOI:10.1038/s41598-023-40572-0
PMID:37612355
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10447432/
Abstract

We hypothesized that the association between BP and endovascular treatment (EVT) outcomes would differ by baseline perfusion and recanalization status. We identified 388 ICA or M1 occlusion patients who underwent EVT ≤ 24 h from onset with successful recanalization (TICI ≥ 2b). BP was measured at 5-min intervals from arrival and during the procedure. Systolic BPs (SBP) were summarized as dropmax (the maximal decrease over two consecutive measurements), incmax (the maximal increase), mean, coefficient of variation (cv), and standard deviation. Adequate baseline perfusion was defined as hypoperfusion intensity ratio (HIR) ≤ 0.5; infarct proportion as the volume ratio of final infarcts within the T > 6 s region. In the adequate perfusion group, infarct proportion was closely associated with SBP (β ± SE (P-value); 1.22 ± 0.48, (< 0.01)), SBP (1.12 ± 0.33, (< 0.01)), SBP (0.61 ± 0.15 (< 0.01)), SBP (0.66 ± 0.08 (< 0.01)), and SBP (0.71 ± 0.37 (0.053) before recanalization. The associations remained significant only in SBP, SBP, and SBP after recanalization. SBP, SBP and SBP showed significant associations with modified Rankin Scale score at 3 months in the pre-recanalization period. In the poor perfusion group, none of the SBP indices was associated with any stroke outcomes regardless of recanalization status. BP may show differential associations with stroke outcomes by the recanalization and baseline perfusion status.

摘要

我们假设,血压(BP)与血管内治疗(EVT)结局的相关性可能因基线灌注和再通状态而不同。我们纳入了 388 例接受 EVT 治疗且在发病后 24 小时内成功再通(TICI≥2b)的颈内动脉或大脑中动脉闭塞患者。BP 在到达后 5 分钟间隔和治疗过程中进行测量。收缩压(SBP)总结为下降最大值(连续两次测量的最大下降值)、升高最大值(incmax)、平均值、变异系数(cv)和标准差。基线灌注充足定义为低灌注强度比(HIR)≤0.5;梗死比例定义为最终梗死体积与 T>6s 区域的体积比。在灌注充足组,梗死比例与 SBP 密切相关(β±SE(P 值);1.22±0.48,(<0.01))、SBP(1.12±0.33,(<0.01))、SBP(0.61±0.15(<0.01))、SBP(0.66±0.08(<0.01))和 SBP(0.71±0.37(0.053))。再通前的 SBP、SBP 和 SBP 也与再通后显著相关。SBP、SBP 和 SBP 在再通前与 3 个月时改良 Rankin 量表评分有显著相关性。在灌注不良组中,无论再通状态如何,SBP 指数均与任何卒中结局均无相关性。BP 可能通过再通和基线灌注状态与卒中结局有不同的相关性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496a/10447432/edcb1269aef2/41598_2023_40572_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496a/10447432/2f768ddacca0/41598_2023_40572_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496a/10447432/0567faba6bb9/41598_2023_40572_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496a/10447432/edcb1269aef2/41598_2023_40572_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496a/10447432/2f768ddacca0/41598_2023_40572_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496a/10447432/0567faba6bb9/41598_2023_40572_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/496a/10447432/edcb1269aef2/41598_2023_40572_Fig3_HTML.jpg

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本文引用的文献

1
Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis.血管内血栓切除术治疗后血压与急性缺血性脑卒中患者结局的关系:一项个体患者数据的荟萃分析。
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Hemodynamics of Leptomeningeal Collaterals after Large Vessel Occlusion and Blood Pressure Management with Endovascular Treatment.
大血管闭塞后软脑膜侧支循环的血流动力学及血管内治疗的血压管理
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