Blood Pressure and Outcome After Mechanical Thrombectomy: A Multicenter Study

Introduction: Hypertension is a known predictor of poor outcome and hemorrhagic complications after ischemic stroke. However, the effect of blood pressure (BP) on outcome of those undergoing mechanical thrombectomy and especially after successful recanalization is not well understood. In this study, we investigated the association between BP parameters and outcome measures after successful recanalization with MT. Methods: This was a retrospective, multicenter study, involving 7 comprehensive stroke centers, of patients with acute ischemic stroke due to large vessel occlusion who achieved successful recanalization with MT. Systolic BP (SBP), diastolic BP (DBP) and mean arterial pressure (MAP) were obtained at frequent intervals (at least hourly) for each patient in the first 24 hours following MT. Outcome measures included 90 day-modified Rankin Scale (mRS), 90-day morality, and symptomatic intracerebral hemorrhage (sICH). Successful recanalization was defined as TICI 2b-3, and sICH as any hemorrhage associated with > 4 points increase in NIHSS. A mixed logistic model was used to identify predictors of functional and hemorrhagic outcomes. Results: A total of 989 patients were included, of whom 453 (45.8%) achieved good outcome, defined as an mRS of 0-2. Mean, and maximum SBP were higher in the poor outcome group (131.6 +15 vs. 127 +14.3; p <0.001, and 166± 24.7 vs. 158±24.3; p<0.001, respectively). There was no significant difference in the rest of BP measurement between the two groups. With respect to hemorrhagic complications, 40 (4.2%) patients develop sICH after MT. SBP, DBP and MAP were higher in sICH group. Table 1 summarizes multivariable analysis results. Conclusion: Higher blood pressure was associated with hemorrhagic complications, and worse functional outcome following successful mechanical thrombectomy.