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Admission Blood Pressure in Relation to Clinical Outcomes and Successful Reperfusion After Endovascular Stroke Treatment

2020; Lippincott Williams & Wilkins; Volume: 51; Issue: 11 Linguagem: Inglês

10.1161/strokeaha.120.029907

1524-4628

Sophie A. van den Berg, Simone M. Uniken Venema, Maxim J.H.L. Mulder, Kilian M. Treurniet, Noor Samuels, Hester F. Lingsma, Robert‐Jan B. Goldhoorn, Ivo G.H. Jansen, Jonathan M. Coutinho, Bob Roozenbeek, Diederik W.J. Dippel, Yvo B.W.E.M. Roos, H. Bart van der Worp, Paul J. Nederkoorn, Aad van der Lugt, Charles B.L.M. Majoie, Robert J. van Oostenbrugge, Wim H. van Zwam, Jan Albert Vos, Josje Brouwer, Sanne J. den Hartog, Wouter H. Hinsenveld, Manon Kappelhof, Kars C.J. Compagne, Aad van der Lugt, Adriaan C.G.M. van Es, Charles B.L.M. Majoie, Bart J. Emmer, Wouter J. Schonewille, Jan Albert Vos, Marieke J.H. Wermer, Marianne A.A. van Walderveen, Julie Staals, Robert J. van Oostenbrugge, Wim H. van Zwam, Jeannette Hofmeijer, Jasper M. Martens, Geert J. Lycklama à Nijeholt, Jelis Boiten, Sebastiaan F. de Bruijn, Lukas C. van Dijk, Rob H. Lo, Ewoud J. van Dijk, Hieronymus D. Boogaarts, J. de Vries, Paul L.M. de Kort, Julia van Tuijl, Jo P. Peluso, Puck Fransen, Jan S.P. van den Berg, Boudewijn A.A.M. van Hasselt, Leo A.M. Aerden, René J. Dallinga, Maarten Uyttenboogaart, Omid Eschgi, Reinoud P.H. Bokkers, Tobien H.C.M.L. Schreuder, Roel J.J. Heijboer, Koos Keizer, Lonneke S.F. Yo, Heleen M. den Hertog, Emiel J.C. Sturm, Paul J.A.M. Brouwers, Charles B.L.M. Majoie, Wim H. van Zwam, Aad van der Lugt, Geert J. Lycklama à Nijeholt, Marianne A.A. van Walderveen, Marieke E.S. Sprengers, Sjoerd F.M. Jenniskens, René van den Berg, Albert J. Yoo, Ludo F.M. Beenen, Alida A. Postma, Stefan D. Roosendaal, Bas F.W. van der Kallen, Ido R. van den Wijngaard, Adriaan C.G.M. van Es, Bart J. Emmer, Jasper M. Martens, Lonneke S.F. Yo, Jan Albert Vos, Joost Bot, Pieter‐Jan van Doormaal, Anton Meijer, Elyas Ghariq, Reinoud P.H. Bokkers, Marc P. van Proosdij, G. Menno Krietemeijer, Jo P. Peluso, Hieronymus D. Boogaarts, Rob H. Lo, Dick Gerrits, Wouter Dinkelaar, Auke P.A. Appelman, Bas Hammer, Sjoert Pegge, Anouk van der Hoorn, Saman Vinke, Aad van der Lugt, Charles B.L.M. Majoie, Robert J. van Oostenbrugge, Wim H. van Zwam, Geert J. Lycklama à Nijeholt, Jelis Boiten, Jan Albert Vos, Wouter J. Schonewille, Jeannette Hofmeijer, Jasper M. Martens, Rob H. Lo, Robert J. van Oostenbrugge, Jeannette Hofmeijer, H. Zwenneke Flach, Naziha el Ghannouti, Martin Sterrenberg, Corina Puppels, Wilma Pellikaan, Rita Sprengers, Marjan Elfrink, Michelle Simons, Marjolein Vossers, Joke de Meris, Tamara Vermeulen, Annet Geerlings, Gina van Vemde, Tiny Simons, Cathelijn van Rijswijk, Gert Messchendorp, Nynke Nicolaij, Hester Bongenaar, Karin Bodde, Sandra Kleijn, Jasmijn Lodico, Hanneke Droste, Maureen Wollaert, Sabrina Verheesen, D. Jeurrissen, Erna Bos, Yvonne Drabbe, Michelle Sandiman, Marjan Elfrink, Nicoline Aaldering, Berber Zweedijk, Mostafa Khalilzada, Jocova Vervoort, Hanneke Droste, Nynke Nicolaij, Michelle Simons, Eva Ponjee, Sharon Romviel, Karin Kanselaar, Erna Bos, Denn Barning, Esmée Venema, Vicky Chalos, Ralph R. Geuskens, Tim van Straaten, Saliha Ergezen, Roger R.M. Harmsma, Daan Muijres, Anouk de Jong, Olvert A. Berkhemer, Anna M.M. Boers, J. Huguet, P.F.C. Groot, Marieke A. Mens, Katinka R. van Kranendonk, Manon L. Tolhuisen, Heitor Alves, Annick J. Weterings, Eleonora L.F. Kirkels, Eva J.H.F. Voogd, Lieve M. Schupp, Sabine L. Collette, Adrien E.D. Groot, Natalie E. LeCouffe, Praneeta R. Konduri, Haryadi Prasetya, Nerea Arrarte‐Terreros, Lucas A. Ramos,

Venous Thromboembolism Diagnosis and Management

Optimal blood pressure (BP) targets before endovascular treatment (EVT) for acute ischemic stroke are unknown. We aimed to assess the relation between admission BP and clinical outcomes and successful reperfusion after EVT.We used data from the MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry, an observational, prospective, nationwide cohort study of patients with ischemic stroke treated with EVT in routine clinical practice in the Netherlands. Baseline systolic BP (SBP) and diastolic BP (DBP) were recorded on admission. The primary outcome was the score on the modified Rankin Scale at 90 days. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2B-3), symptomatic intracranial hemorrhage, and 90-day mortality. Multivariable logistic and linear regression were used to assess the associations of SBP and DBP with outcomes. The relations between BPs and outcomes were tested for nonlinearity. Parameter estimates were calculated per 10 mm Hg increase or decrease in BP.We included 3180 patients treated with EVT between March 2014 and November 2017. The relations between admission SBP and DBP with 90-day modified Rankin Scale scores and mortality were J-shaped, with inflection points around 150 and 81 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome (adjusted common odds ratio, 1.09 [95% CI, 1.04-1.15]) and mortality at 90 days (adjusted odds ratio, 1.09 [95% CI, 1.03-1.16]). Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion (adjusted odds ratio, 0.97 [95% CI, 0.94-0.99]) and with the occurrence of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.06 [95% CI, 0.99-1.13]). Results for DBP were largely similar.In patients with acute ischemic stroke treated with EVT, higher admission BP is associated with lower probability of successful reperfusion and with poor clinical outcomes. Further research is needed to investigate whether these patients benefit from BP reduction before EVT.