Association between blood pressure and endovascular treatment outcomes differs by baseline perfusion and reperfusion status

Abstract

We hypothesized that the association between BP and endovascular treatment (EVT) outcomes would differ by baseline perfusion and recanalization status. We identified 388 ICA or M1 occlusion patients who underwent EVT ≤ 24 h from onset with successful recanalization (TICI ≥ 2b). BP was measured at 5-min intervals from arrival and during the procedure. Systolic BPs (SBP) were summarized as dropmax (the maximal decrease over two consecutive measurements), incmax (the maximal increase), mean, coefficient of variation (cv), and standard deviation. Adequate baseline perfusion was defined as hypoperfusion intensity ratio (HIR) ≤ 0.5; infarct proportion as the volume ratio of final infarcts within the T_max > 6 s region. In the adequate perfusion group, infarct proportion was closely associated with SBP_dropmax (β ± SE (P-value); 1.22 ± 0.48, (< 0.01)), SBP_incmax (1.12 ± 0.33, (< 0.01)), SBP_cv (0.61 ± 0.15 (< 0.01)), SBP_sd (0.66 ± 0.08 (< 0.01)), and SBP_mean (0.71 ± 0.37 (0.053) before recanalization. The associations remained significant only in SBP_dropmax, SBP_incmax, and SBP_mean after recanalization. SBP_incmax, SBP_cv and SBP_sd showed significant associations with modified Rankin Scale score at 3 months in the pre-recanalization period. In the poor perfusion group, none of the SBP indices was associated with any stroke outcomes regardless of recanalization status. BP may show differential associations with stroke outcomes by the recanalization and baseline perfusion status.