High values of baseline and 24-hour Mean Arterial Pressure are associated with lower chance of early neurological improvement in acute stroke patients treated with thrombolysis (P4.286)

Objective: To evaluate whether mean arterial pressure(MAP), as marker of brain perfusion, is associated with early neurological improvement(ENI) in patients with acute ischemic stroke(AIS) treated with IV thrombolysis and whether it can modulate treatment response in terms of infarct volume and long-term outcome, particularly in patients with radiographic signs of small vessel disease. Background: Studies on relationship between BP and stroke outcome in hyperacute phase of ischemic stroke have shown contradictory results. Design/Methods: We analyzed data of AIS patients treated with IV rt-PA at the Sapienza University stroke unit from 2012 to 2015 and entered into SITS-ISTR(Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Register). MAP was obtained at baseline, 2h, 24h,7d/discharge. MAP changes from baseline were calculated. ENI was defined as decrease of 4 points or more at 24-hr NIHSS from baseline. Results: Overall,423 patients were included,183(43.3%) had ENI. Patients with ENI were more likely to have lower MAP values at baseline and 24 hours. In multivariate analysis including the antihypertensive treatment prior to the index stroke, MAP at baseline resulted as independent predictor of ENI(OR0.98,95%CI 0.96–0.99;p=0.026). After including antihypertensive treatment during the hospital stay in the model, 24-hr MAP was selected as independent predictor of ENI(OR0.97,95%CI 0.95–0.99;p=0.015). Higher baseline and 24h MAP values were associated with poor outcome(mRS 3–6) at discharge and 3 months, respectively(all p Conclusions: High baseline and 24-hr MAP values are associated with lower chance of achieving ENI after IV thrombolysis. Further studies are needed to better understand whether acute BP dysregulation can influence different clinical courses in the early phase of IV thrombolysis. Disclosure: Dr. Lorenzano has nothing to disclose. Dr. Caselli has nothing to disclose. Dr. Zingaro has nothing to disclose. Dr. Orlando has nothing to disclose. Dr. Toni has received research support from Bayer, Medtronic, and Boehriger Ingelheim.