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In the first 24 hours after a stroke , blood pressure often rises even after endovascular treatment (EVT), and it takes several days to return to baseline levels
.
Studies have shown that blood pressure at admission is closely related to the functional outcome after EVT
.
Since blood pressure is an important factor affecting cerebral perfusion, blood pressure in the first few hours after EVT is likely to affect the infarct size, thereby affecting the functional outcome
However, these studies did not link the time of blood pressure measurement with the occurrence of sICH, so there may be a reverse causality.
The target blood pressure level in the first few hours after EVT is still unclear
.
However, if there is a causal relationship between blood pressure and outcome, the use of medication modifications may be a viable strategy to improve functional outcomes
.
.
In this way, Noor Samuels and others at the University of Rotterdam Medical Center explored the relationship between SBP and functional outcomes and the occurrence of sICH within the first 6 hours after EVT
.
They analyzed patients from 8 MR CLEAN (Netherlands Multi-center Randomized Controlled Trial of Endovascular Treatment of Acute Ischemic Stroke) registry.
These patients had SBP data within 6 hours after EVT
.
And evaluated the highest, lowest and average SBP
Main outcome: functional outcome (modified Rankin scale) and symptomatic intracranial hemorrhage after 90 days
.
And used multivariate ordinal and binary regression analysis to adjust the important prognostic factors, and studied the effect changes that may be brought about by successful reperfusion
SBP data after EVT for 1161/1796 patients is available
.
A higher maximum SBP (Higher maximum SBP) (in increments of 10 mmHg) is associated with a poorer functional prognosis (and a higher rate of symptomatic intracranial hemorrhage
.
The association between minimum SBP and functional outcome is non-linear, with an inflection point at 124 mmHg
.
The lowest SBP below and above the inflection point is associated with worse functional results (adjusted OR=1.
17, 0.
85 [95%CI, 0.
76-0.
95] per 10 mmHg, adjusted common odds ratio, every 10 Mm Hg increased by 0.
81 [95% CI, 0.
71-0.
92])
.
No association between average SBP and functional outcome was observed
.
Successful reperfusion did not change the relationship between SBP and any outcome
.
The significance of this study is that it found that in the first 6 hours after EVT, the highest SBP was positively correlated with worse functional outcome and increased risk of symptomatic intracranial hemorrhage
.
In the first 6 hours after EVT, the highest SBP is positively correlated with worse functional outcome and increased risk of symptomatic intracranial hemorrhage
Original source:
Samuels N, van de Graaf RA, van den Berg CAL, et al.
Blood Pressure in the First 6 Hours Following Endovascular Treatment for Ischemic Stroke Is Associated With Outcome.
Stroke.
Published online September 20, 2021.
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