Xu Hongye, Li He, Zhang Ping, Gao Yuan, Liu Hanchen, Shen Hongjian, Hua Weilong, Zhang Lei, Li Zifu, Zhang Yongxin, Xing Pengfei, Zhang Xiaoxi, Yang Pengfei, Liu Jianmin
Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China.
No. 904 Hospital of the PLA Joint Logistics Support Force, Wuxi, China.
Front Neurol. 2023 Nov 10;14:1238653. doi: 10.3389/fneur.2023.1238653. eCollection 2023.
An aggressive lowering of blood pressure (BP) could lead to neurological worsening, particularly of the area that has not been reperfused in acute stroke patients with large vessel occlusion (LVO). We sought to investigate the association of reperfusion status and BP course following mechanical thrombectomy (MT) with outcomes in LVO.
Consecutive patients with LVO treated with MT between Jan 2020 to Jun 2021 were enrolled in a retrospective cohort study. Hourly systolic BP (SBP) and diastolic BP (DBP) were recorded for 72 h following MT and maximum SBP and DBP levels were identified. The Extended Thrombolysis in Cerebral Infarction (eTICI) scale was used to assess reperfusion extent. LVO patients were stratified in 2 groups based on reperfusion status: complete reperfusion (eTICI 3) and incomplete reperfusion (eTICI 2b/c). Three-month functional independence was defined as a modified Rankin Scale score of 0-2.
A total of 263 acute ischemic stroke patients with LVO were retrospectively evaluated. Complete reperfusion was achieved in 210 patients (79.8%). Post-MT maximum SBP over 160 mmHg was significantly related to worse functional outcome (38.1% vs. 55.7%, = 0.006), higher likelihood of in-hospital mortality and 3-month mortality (19.0% vs. 6.9%, = 0.004, 27.4% vs. 14.3%, = 0.012). No statistical correlation was found between reperfusion status and blood pressure level ( > 0.05). In patients with complete reperfusion, patients with an average BP 120-140 mmHg tends to have worse functional outcome compared with 100-120 mmHg (OR = 1.77, 95%CI: 0.97-3.23, = 0.061).
High maximum SBP levels following MT are associated with an increased likelihood of 3-month functional dependence and mortality. An average BP of 100-120 mmHg tends to have better functional independence in completely reperfused patients. The effect of intensive BP control on incomplete reperfusion still warrants further investigations.
积极降低血压可能导致神经功能恶化，尤其是在大血管闭塞（LVO）的急性卒中患者中未实现再灌注的区域。我们试图研究机械取栓（MT）后再灌注状态和血压变化过程与LVO患者预后的关系。
纳入2020年1月至2021年6月期间接受MT治疗的连续LVO患者进行回顾性队列研究。MT后72小时每小时记录收缩压（SBP）和舒张压（DBP），并确定SBP和DBP的最高水平。采用脑梗死扩展溶栓（eTICI）量表评估再灌注程度。根据再灌注状态将LVO患者分为两组：完全再灌注（eTICI 3）和不完全再灌注（eTICI 2b/c）。三个月功能独立定义为改良Rankin量表评分为0 - 2分。
共回顾性评估了263例急性缺血性卒中LVO患者。210例患者（79.8%）实现了完全再灌注。MT后最高SBP超过160 mmHg与较差的功能预后显著相关（38.1%对55.7%，P = 0.006），住院死亡率和3个月死亡率更高（19.0%对6.9%，P = 0.004，27.4%对14.3%，P = 0.012）。再灌注状态与血压水平之间未发现统计学相关性（P>0.05）。在完全再灌注的患者中，平均血压120 - 140 mmHg的患者与100 - 120 mmHg的患者相比，功能预后往往较差（OR = 1.77，95%CI：0.97 - 3.23，P = 0.061）。
MT后最高SBP水平升高与3个月功能依赖和死亡的可能性增加有关。平均血压100 - 120 mmHg在完全再灌注的患者中往往具有更好的功能独立性。强化血压控制对不完全再灌注的影响仍需进一步研究。
