Huang Xianjun, Ding Xianhui, Wang Hao, Cai Qiankun, Xu Junfeng, Li Zibao, Yang Qian, Zhou Zhiming, Xu Jie
Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China.
The Department of Neurology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, FuJian, China.
Stroke Vasc Neurol. 2025 Apr 29;10(2):e003221. doi: 10.1136/svn-2024-003221.
The impact of lowering systolic blood pressure (SBP) following endovascular treatment (EVT) in acute large vessel occlusion stroke (LVOS) patients remains unclear. We aimed to explore the effect of the magnitude of SBP reduction (SBPr) after EVT on outcomes in LVOS patients.
We consecutively registered patients at three comprehensive stroke centres who had experienced EVT as a result of acute anterior circulation LVOS. SBPr was calculated as follows: (baseline SBP-mean SBP/baseline SBP)×100%. The 90-day modified Rankin Scale score ranging from 0 to 2 was defined as a favourable functional outcome. Based on CT scans obtained within 24 hours after procedure, symptomatic intracranial haemorrhage (sICH) was assessed according to the criteria of the European Cooperative Acute Stroke Study III.
We enrolled 1080 patients, of which 908 (84.1%) had successful recanalisation. In the overall cohort, SBPr was correlated with lower odds of sICH (SBPr±10% as a reference, 20%-30%: OR 0.460; 95% CI: 0.245 to 0.864; p=0.016; >30%: OR 0.304; 95% CI 0.123 to 0.749; p=0.010). In patients who achieved successful reperfusion, SBPr>30% was correlated with higher odds of a poor outcome (SBPr±10% as a reference, OR 2.150; 95% CI 1.268 to 3.645; p=0.004) and SBPr has a similar tendency towards reducing the incidence of sICH. In the subgroup analyses, baseline Alberta Stroke Programme Early CT (ASPECT) score (p=0.024) modified the effect of SBPr on the 90-day outcome.
Among patients with EVT, a significant drop in SBP may be related to a poor functional outcome and a reduced incidence of sICH. Baseline ASPECT score may be an important interacting factor in the association of SBPr with the 90-day outcome. This study provides new insights for individualised BP management in patients with EVT.
血管内治疗（EVT）后降低急性大血管闭塞性卒中（LVOS）患者的收缩压（SBP）的影响尚不清楚。我们旨在探讨EVT后SBP降低幅度（SBPr）对LVOS患者预后的影响。
我们连续登记了三个综合卒中中心因急性前循环LVOS接受EVT治疗的患者。SBPr的计算方法如下：（基线SBP - 平均SBP/基线SBP）×100%。90天改良Rankin量表评分在0至2分之间被定义为良好的功能预后。根据术后24小时内获得的CT扫描结果，按照欧洲急性卒中协作研究III的标准评估症状性颅内出血（sICH）。
我们纳入了1080例患者，其中908例（84.1%）实现了再通。在整个队列中，SBPr与较低的sICH发生率相关（以SBPr±10%为参照，20% - 30%：OR 0.460；95%CI：0.245至0.864；p = 0.016；>30%：OR 0.304；95%CI 0.123至0.749；p = 0.010）。在实现成功再灌注的患者中，SBPr>30%与较差预后的较高几率相关（以SBPr±10%为参照，OR 2.150；95%CI 1.268至3.645；p = 0.004），且SBPr在降低sICH发生率方面有类似趋势。在亚组分析中，基线阿尔伯塔卒中项目早期CT（ASPECT）评分（p = 0.024）改变了SBPr对90天预后的影响。
在接受EVT治疗的患者中，SBP显著下降可能与功能预后不良和sICH发生率降低有关。基线ASPECT评分可能是SBPr与90天预后关联中的一个重要相互作用因素。本研究为EVT患者的个体化血压管理提供了新的见解。
