Association between systolic blood pressure parameters and unexplained early neurological deterioration (UnND) in acute ischemic stroke patients treated with mechanical thrombectomy

Aleksandras Vilionskis; Virginija Gaigalaite; Lukas Salasevicius; Dalius Jatuzis

doi:10.1177/17562864221093524

Association between systolic blood pressure parameters and unexplained early neurological deterioration (UnND) in acute ischemic stroke patients treated with mechanical thrombectomy

Ther Adv Neurol Disord. 2022 Jun 16:15:17562864221093524. doi: 10.1177/17562864221093524. eCollection 2022.

Authors

Aleksandras Vilionskis¹, Virginija Gaigalaite², Lukas Salasevicius¹, Dalius Jatuzis¹

Affiliations

¹ Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
² Institute of Clinical Medicine, Vilnius University, Siltnamiu 29, Vilnius 01513, Lithuania.

Abstract

Background: Neurological deterioration (ND) after mechanical thrombectomy (MT) of acute ischemic stroke (AIS) in anterior circulation is an important complication associated with a poor outcome. Moreover, evident causes of ND may remain unexplained (UnND).

Objective: We sought to evaluate the association of the systolic blood pressure (SBP) parameters before MT, during MT, and during a 24-h period after MT with UnND.

Methods: We analyzed 382 MT-treated AIS patients in two stroke centers from 2017 to 2019. The patients with unsuccessful recanalization and/or with symptomatic intracerebral hemorrhage after MT were excluded. Multivariate logistic regression analysis was used to identify the SBP parameters that predict UnND.

Results: There were 5.9% patients with UnND within 24 h after MT among patients with successful recanalization what comprises 4.9% of all patients who had undergone MT. SBP > 180 mmHg on admission (odds ratio (OR): 4, 95% confidence interval (CI): 1.6-10, p = 0.004) and a drop of SBP below100 mmHg during MT (OR: 4.7, 95% CI: 1.3-17, p = 0.019) were associated with UnND occurrence within 7 days without a significant association with UnND within 24 h. UnND within 7 days was predicted by the episodes of SBP exceeding the level of SBP observed before the groin puncture and occurring over the first 2 h following recanalization (OR: 5, 95% CI: 1.3-19, p = 0.021), an increase of SBP of more than 20% within 2-24 h after MT (OR: 3.4, 95% CI: 1.1-10, p = 0.035), and a drop of SBP below 100 mmHg after MT (OR: 3.2, 95% CI: 1.1-9, p = 0.039).

Conclusion: The association between the SBP parameters and UnND depends on the treatment period and the time of UnND occurrence. The J/U resembling relationship between SBP and UnEND was established during a 24-h period after MT.

Keywords: blood pressure; mechanical thrombectomy; neurological deterioration; stroke.