Nitin Goyal1, Georgios Tsivgoulis2, Abhi Pandhi2, Jason J Chang2, Kira Dillard2, Muhammad Fawad Ishfaq2, Katherine Nearing2, Asim F Choudhri2, Daniel Hoit2, Anne W Alexandrov2, Adam S Arthur2, Lucas Elijovich2, Andrei V Alexandrov2. 1. From the Departments of Neurology (N.G., G.T., A.P., J.J.C., K.D., M.F.I., K.N., A.W.A., L.E., A.V.A.), Radiology (A.F.C.), and Neurosurgery (D.H., A.S.A., L.E.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T.), "Attikon University Hospital," School of Medicine, National & Kapodistrian University of Athens, Greece; and Semmes-Murphey Neurologic and Spine Clinic (D.H., A.S.A., L.E.), Memphis, TN. ngoyal@uthsc.edu. 2. From the Departments of Neurology (N.G., G.T., A.P., J.J.C., K.D., M.F.I., K.N., A.W.A., L.E., A.V.A.), Radiology (A.F.C.), and Neurosurgery (D.H., A.S.A., L.E.), University of Tennessee Health Science Center, Memphis; Second Department of Neurology (G.T.), "Attikon University Hospital," School of Medicine, National & Kapodistrian University of Athens, Greece; and Semmes-Murphey Neurologic and Spine Clinic (D.H., A.S.A., L.E.), Memphis, TN.
Abstract
OBJECTIVE: There are limited data evaluating the effect of post mechanical thrombectomy (MT) blood pressure (BP) levels on early outcomes of patients with large vessel occlusions (LVO). We sought to investigate the association of BP course following MT with early outcomes in LVO. METHODS: Consecutive patients with LVO treated with MT during a 3-year period were evaluated. Hourly systolic BP (SBP) and diastolic BP (DBP) values were recorded for 24 hours following MT and maximum SBP and DBP levels were identified. LVO patients with complete reperfusion following MT were stratified in 3 groups based on post-MT achieved BP goals: <140/90 mm Hg (intensive), <160/90 mm Hg (moderate), and <220/110 mm Hg or <180/105 mm Hg when pretreated with IV thrombolysis (permissive hypertension). Three-month functional independence was defined as modified Rankin Scale score of 0-2. RESULTS: A total of 217 acute ischemic stroke patients with LVO were prospectively evaluated. A 10 mm Hg increment in maximum SBP documented during the first 24 hours post MT was independently (p = 0.001) associated with a lower likelihood of 3-month functional independence (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.56-0.87) and a higher odds of 3-month mortality (OR 1.49; 95% CI 1.18-1.88) after adjusting for potential confounders. In addition, achieving a BP goal of <160/90 mm Hg during the first 24 hours following MT was independently associated with a lower likelihood of 3-month mortality (OR 0.08; 95% CI 0.01-0.54; p = 0.010) in comparison to permissive hypertension. CONCLUSIONS: High maximum SBP levels following MT are independently associated with increased likelihood of 3-month mortality and functional dependence in LVO patients. Moderate BP control is also related to lower odds of 3-month mortality in comparison to permissive hypertension.
OBJECTIVE: There are limited data evaluating the effect of post mechanical thrombectomy (MT) blood pressure (BP) levels on early outcomes of patients with large vessel occlusions (LVO). We sought to investigate the association of BP course following MT with early outcomes in LVO. METHODS: Consecutive patients with LVO treated with MT during a 3-year period were evaluated. Hourly systolic BP (SBP) and diastolic BP (DBP) values were recorded for 24 hours following MT and maximum SBP and DBP levels were identified. LVO patients with complete reperfusion following MT were stratified in 3 groups based on post-MT achieved BP goals: <140/90 mm Hg (intensive), <160/90 mm Hg (moderate), and <220/110 mm Hg or <180/105 mm Hg when pretreated with IV thrombolysis (permissive hypertension). Three-month functional independence was defined as modified Rankin Scale score of 0-2. RESULTS: A total of 217 acute ischemic strokepatients with LVO were prospectively evaluated. A 10 mm Hg increment in maximum SBP documented during the first 24 hours post MT was independently (p = 0.001) associated with a lower likelihood of 3-month functional independence (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.56-0.87) and a higher odds of 3-month mortality (OR 1.49; 95% CI 1.18-1.88) after adjusting for potential confounders. In addition, achieving a BP goal of <160/90 mm Hg during the first 24 hours following MT was independently associated with a lower likelihood of 3-month mortality (OR 0.08; 95% CI 0.01-0.54; p = 0.010) in comparison to permissive hypertension. CONCLUSIONS: High maximum SBP levels following MT are independently associated with increased likelihood of 3-month mortality and functional dependence in LVO patients. Moderate BP control is also related to lower odds of 3-month mortality in comparison to permissive hypertension.
Authors: Nils H Petersen; Andrew Silverman; Sumita M Strander; Sreeja Kodali; Anson Wang; Lauren H Sansing; Joseph L Schindler; Guido J Falcone; Emily J Gilmore; Adam S Jasne; Branden Cord; Ryan M Hebert; Michele Johnson; Charles C Matouk; Kevin N Sheth Journal: Stroke Date: 2020-02-12 Impact factor: 7.914
Authors: Konark Malhotra; Nitin Goyal; Aristeidis H Katsanos; Angeliki Filippatou; Eva A Mistry; Pooja Khatri; Mohammad Anadani; Alejandro M Spiotta; Else Charlotte Sandset; Amrou Sarraj; Georgios Magoufis; Christos Krogias; Lars Tönges; Apostolos Safouris; Lucas Elijovich; Mayank Goyal; Adam Arthur; Andrei V Alexandrov; Georgios Tsivgoulis Journal: Hypertension Date: 2020-01-13 Impact factor: 10.190
Authors: Mohammad Anadani; Adam S Arthur; Ali Alawieh; Yser Orabi; Andrei Alexandrov; Nitin Goyal; Marios-Nikos Psychogios; Ilko Maier; Joon-Tae Kim; Saleh G Keyrouz; Adam de Havenon; Nils H Petersen; Abhi Pandhi; Christa B Swisher; Ovais Inamullah; Jan Liman; Sreeja Kodali; James A Giles; Michelle Allen; Stacey Q Wolfe; Georgios Tsivgoulis; Bradley A Cagle; Chesney S Oravec; Benjamin Gory; Pierre De Marini; Peter Kan; Shareena Rahman; Sébastien Richard; Fábio A Nascimento; Alejandro Spiotta Journal: J Neurointerv Surg Date: 2019-12-05 Impact factor: 5.836
Authors: Eva A Mistry; Heidi Sucharew; Akshitkumar M Mistry; Tapan Mehta; Niraj Arora; Amy K Starosciak; Felipe De Los Rios La Rosa; James Ernest Siegler; Natasha R Barnhill; Kishan Patel; Salman Assad; Amjad Tarboosh; Katarina Dakay; Sanjana Salwi; Aurora S Cruz; Jeffrey Wagner; Enzo Fortuny; Alicia Bennett; Robert F James; Bharathi Jagadeesan; Christopher Streib; Kristine O'Phelan; Scott E Kasner; Stewart A Weber; Rohan Chitale; John J Volpi; Stephan Mayer; Shadi Yaghi; Mahesh V Jayaraman; Pooja Khatri Journal: Stroke Date: 2019-10-07 Impact factor: 7.914