Association of Blood Pressure at Successful Recanalization and Parenchymal Hemorrhage After Mechanical Thrombectomy With General Anesthesia

Hui Cheng; Chao Xu; Xing Jin; Yigang Chen; Xu Zheng; Feina Shi; Xudong He; Yonggang Hao; Yun Jiang; Jinhua Zhang; Zhicai Chen

doi:10.3389/fneur.2020.582639

Association of Blood Pressure at Successful Recanalization and Parenchymal Hemorrhage After Mechanical Thrombectomy With General Anesthesia

Front Neurol. 2020 Nov 17:11:582639. doi: 10.3389/fneur.2020.582639. eCollection 2020.

Authors

Hui Cheng¹, Chao Xu², Xing Jin¹, Yigang Chen¹, Xu Zheng¹, Feina Shi¹, Xudong He¹, Yonggang Hao¹, Yun Jiang¹, Jinhua Zhang¹, Zhicai Chen³

Affiliations

¹ Department of Neurology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
² Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China.
³ Department of Neurology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.

Abstract

Background: This study aims to investigate the association between blood pressure (BP) at the time of recanalization and hemorrhagic transformation in large vessel occlusion (LVO) patients following mechanical thrombectomy (MT) with general anesthesia. Methods: We retrospectively reviewed our data base for patients with acute ischemic stroke acute ischemic stroke (AIS) who received MT between January 2018 and December 2019. The BP at two adjacent time points immediately after successful recanalization was recorded for subsequent calculation of mean BP (BP_mean), maximum BP (BP_max), minimum BP (BP_min), range of BP (BP_range), and standard deviation of SP (BP_SD). Hemorrhagic transformation was identified on 24-h computerized tomography images according to the European Cooperative Acute Stroke Study (ECASS) III trial. We used binary logistic regression analysis to investigate the association of BP parameters and the incidence of parenchymal hemorrhage (PH) and PH-2. Results: A total of 124 patients with anterior circulation LVO were finally included for analyses. After controlling for intravenous thrombolysis, procedure duration of mechanical thrombectomy, baseline National institutes of Health Stroke Scale (NIHSS), baseline ASPECTS, and number of device passes, the results showed that every increment of 10 mmHg in SBP_range (OR 1.559; 95% CI 1.027-2.365; P = 0.037) and SBP_SD (OR 1.998; 95% CI 1.017-3.925; P = 0.045) were independently associated with PH. After adjustment for intravenous thrombolysis, procedure duration of mechanical thrombectomy, baseline NIHSS, the results showed that every increment of 10 mmHg in SBP_mean (OR 1.973; 95% CI 1.190-3.271; P = 0.008), SBP_max (OR 1.838; 95% CI 1.199 to 2.815; P = 0.005), SBP_range (OR 1.908; 95% CI 1.161-3.136; P = 0.011) and SBP_SD (OR 2.573; 95% CI 1.170-5.675; P = 0.019) were independently associated with PH-2. Conclusion: Patients with higher systolic BP and variability at the time of successful recanalization were more likely to have PH-2 in LVO patients following MT with general anesthesia.

Keywords: blood pressure; hemorrhagic transformation; large artery occlusion; mechanical thrombectomy; recanalization.