Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis

Aristeidis H Katsanos; Konark Malhotra; Niaz Ahmed; Georgios Seitidis; Eva A Mistry; Dimitris Mavridis; Joon-Tae Kim; Areti Angeliki Veroniki; Ilko Maier; Marius Matusevicius; Pooja Khatri; Mohammad Anadani; Nitin Goyal; Adam S Arthur; Amrou Sarraj; Shadi Yaghi; Ashkan Shoamanesh; Luciana Catanese; Maria Kantzanou; Theodora Psaltopoulou; Alexandros Rentzos; Marios Psychogios; Brian Van Adel; Alejandro M Spiotta; Else Charlotte Sandset; Adam de Havenon; Andrei V Alexandrov; Nils H Petersen; Georgios Tsivgoulis

doi:10.1212/WNL.0000000000013049

Blood Pressure After Endovascular Thrombectomy and Outcomes in Patients With Acute Ischemic Stroke: An Individual Patient Data Meta-analysis

Neurology. 2022 Jan 18;98(3):e291-e301. doi: 10.1212/WNL.0000000000013049. Epub 2021 Nov 12.

Authors

Aristeidis H Katsanos¹, Konark Malhotra², Niaz Ahmed², Georgios Seitidis², Eva A Mistry², Dimitris Mavridis², Joon-Tae Kim², Areti Angeliki Veroniki², Ilko Maier², Marius Matusevicius², Pooja Khatri², Mohammad Anadani², Nitin Goyal², Adam S Arthur², Amrou Sarraj², Shadi Yaghi², Ashkan Shoamanesh², Luciana Catanese², Maria Kantzanou², Theodora Psaltopoulou², Alexandros Rentzos², Marios Psychogios², Brian Van Adel², Alejandro M Spiotta², Else Charlotte Sandset², Adam de Havenon², Andrei V Alexandrov², Nils H Petersen², Georgios Tsivgoulis²

Affiliations

¹ From the Division of Neurology (A.H.K., A. Shoamanesh, L.C.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Second Department of Neurology (A.H.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (K.M.), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (N.A., M.M.), Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Primary Education (G.S., D.M., A.V.), University of Ioannina, Greece; Department of Neurology (E.A.M.), Vanderbilt University Medical Center, Nashville, TN; Paris Descartes University (D.M.), Sorbonne Paris Cité, Faculté de Médecine, France; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea; Li Ka Shing Knowledge Institute (A.V.), St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Institute of Reproductive and Developmental Biology (A.V.), Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK; Department of Neurology (I.M.), University Medical Center Goettingen, Germany; Department of Neurology (P.K.), University of Cincinnati, OH; Departments of Neurology (M.A.) and Neurosurgery (M.A., A.M.S.), Medical University of South Carolina, Charleston; Departments of Neurology (N.G., A.V.A., G.T.) and Neurosurgery (N.G., A.S.A.), University of Tennessee Health Science Center, Memphis; Department of Neurology (A. Sarraj), UTHealth, Houston; Department of Neurology (S.Y.), NYU Langone Health, New York; Department of Hygiene, Epidemiology and Medical Statistics (M.K., T.P.), Medical School, National and Kapodistrian University of Athens, Greece; Diagnostic and Interventional Neuroradiology (A.R.), Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland; Division of Neurology, Neurosurgery, and Diagnostic Imaging (B.V.A.), Hamilton General Hospital, McMaster University, Ontario, Canada; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital; The Norwegian Air Ambulance Foundation (E.C.S.), Oslo, Norway; Department of Neurology (A.d.H.), Clinical Neurosciences Center, University of Utah, Salt Lake City; and Department of Neurology (N.H.P.), Yale University, New Haven, CT. ar.katsanos@gmail.com.
² From the Division of Neurology (A.H.K., A. Shoamanesh, L.C.), McMaster University/Population Health Research Institute, Hamilton, Ontario, Canada; Second Department of Neurology (A.H.K., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Neurology (K.M.), Allegheny Health Network, Pittsburgh, PA; Department of Neurology (N.A., M.M.), Karolinska University Hospital, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Primary Education (G.S., D.M., A.V.), University of Ioannina, Greece; Department of Neurology (E.A.M.), Vanderbilt University Medical Center, Nashville, TN; Paris Descartes University (D.M.), Sorbonne Paris Cité, Faculté de Médecine, France; Department of Neurology (J.-T.K.), Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea; Li Ka Shing Knowledge Institute (A.V.), St. Michael's Hospital, Unity Health Toronto, Ontario, Canada; Institute of Reproductive and Developmental Biology (A.V.), Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, UK; Department of Neurology (I.M.), University Medical Center Goettingen, Germany; Department of Neurology (P.K.), University of Cincinnati, OH; Departments of Neurology (M.A.) and Neurosurgery (M.A., A.M.S.), Medical University of South Carolina, Charleston; Departments of Neurology (N.G., A.V.A., G.T.) and Neurosurgery (N.G., A.S.A.), University of Tennessee Health Science Center, Memphis; Department of Neurology (A. Sarraj), UTHealth, Houston; Department of Neurology (S.Y.), NYU Langone Health, New York; Department of Hygiene, Epidemiology and Medical Statistics (M.K., T.P.), Medical School, National and Kapodistrian University of Athens, Greece; Diagnostic and Interventional Neuroradiology (A.R.), Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Sweden; Department of Neuroradiology (M.P.), Clinic for Radiology and Nuclear Medicine, University Hospital Basel, Switzerland; Division of Neurology, Neurosurgery, and Diagnostic Imaging (B.V.A.), Hamilton General Hospital, McMaster University, Ontario, Canada; Department of Neurology (E.C.S.), Stroke Unit, Oslo University Hospital; The Norwegian Air Ambulance Foundation (E.C.S.), Oslo, Norway; Department of Neurology (A.d.H.), Clinical Neurosciences Center, University of Utah, Salt Lake City; and Department of Neurology (N.H.P.), Yale University, New Haven, CT.

PMID: 34772799
DOI: 10.1212/WNL.0000000000013049

Abstract

Background and objectives: To explore the association between blood pressure (BP) levels after endovascular thrombectomy (EVT) and the clinical outcomes of patients with acute ischemic stroke (AIS) patients with large vessel occlusion (LVO).

Methods: A study was eligible if it enrolled patients with AIS >18 years of age with an LVO treated with either successful or unsuccessful EVT and provided either individual or mean 24-hour systolic BP values after the end of the EVT procedure. Individual patient data from all studies were analyzed with a generalized linear mixed-effects model.

Results: A total of 5,874 patients (mean age 69 ± 14 years; 50% women; median NIH Stroke Scale score on admission 16) from 7 published studies were included. Increasing mean systolic BP levels per 10 mm Hg during the first 24 hours after the end of the EVT were associated with a lower odds of functional improvement (unadjusted common odds ratio [OR] 0.82, 95% confidence interval [CI] 0.80-0.85; adjusted common OR 0.88, 95% CI 0.84-0.93) and modified Rankin Scale score ≤2 (unadjusted OR 0.82, 95% CI 0.79-0.85; adjusted OR 0.87, 95% CI 0.82-0.93) and a higher odds of all-cause mortality (unadjusted OR 1.18, 95% CI 1.13-1.24; adjusted OR 1.15, 95% CI 1.06-1.23) at 3 months. Higher 24-hour mean systolic BP levels were also associated with an increased likelihood of early neurologic deterioration (unadjusted OR 1.14, 95% CI 1.07-1.21; adjusted OR 1.14, 95% CI 1.03-1.24) and a higher odds of symptomatic intracranial hemorrhage (unadjusted OR 1.20, 95% CI 1.09-1.29; adjusted OR 1.20, 95% CI 1.03-1.38) after EVT.

Discussion: Increased mean systolic BP levels in the first 24 hours after EVT are independently associated with a higher odds of symptomatic intracranial hemorrhage, early neurologic deterioration, 3-month mortality, and worse 3-month functional outcomes.

Publication types

Meta-Analysis

MeSH terms

Aged
Aged, 80 and over
Blood Pressure / physiology
Brain Ischemia* / complications
Endovascular Procedures* / methods
Female
Humans
Intracranial Hemorrhages / complications
Ischemic Stroke* / surgery
Male
Middle Aged
Stroke*
Thrombectomy / methods
Treatment Outcome