Blood Pressure Reductions In The Hyperacute Phase Of Large Vessel Occlusion Ischemic Stroke Are Associated With Infarct Progression And Poor Functional Outcome.

Objective: To evaluate relation of blood pressure (BP) reductions during hyperacute period of large vessel occlusion (LVO) stroke with infarct progression and functional outcome. Background: BP reductions during endovascular therapy (EVT) have been associated with infarct progression and worse outcome after LVO stroke. However, BP trajectories in the hyperacute phase prior to EVT have not been well characterized. We used high-frequency BP and hemodynamic monitoring to study timing of BP reductions during hyperacute period of stroke. Design/Methods: Patients with LVO undergoing EVT were prospectively enrolled. High frequency BP was recorded using non-invasive finger plethysmography. Patients underwent initial CT perfusion and MRI at 24 hours to calculate infarct growth. Exposure variables were defined as: difference between admission MAP and lowest MAP (ΔMAP), MAP drop \u003e 20%, MAP Results: 45 patients underwent continuous BP monitoring (age 72±17; 58% female; NIHSS 13±6). Aggregated time series data revealed marked BP reduction around the time of imaging from which patients recovered and sustained decrease in BP after groin puncture without return to baseline. Linear regression analysis revealed 13 ml infarct growth for every 10mmHg reduction in ΔMAP (p=0.054). Patients were divided into two groups based on median ΔMAP = 29. Those with ΔMAP ≤29 had better functional outcome at 90 days (34.78% vs. 9.09%, p = 0.038). Conclusions: Marked iatrogenic BP reductions occur around the time of initial imaging and may present a potential target for therapeutic intervention. Decrease in blood pressure before reperfusion may increase the risk of infarct progression and poor functional outcome. Changes in cardiac hemodynamic variables throughout the acute stroke period suggest a potential role for fluid resuscitation for hemodynamic optimization. Disclosure: Dr. Peshwe has nothing to disclose. Miss Nguyen has nothing to disclose. Ms. Kodali has nothing to disclose. Ms. Kobsa has nothing to disclose. Mr. Prasad has nothing to disclose. Ms. Soto has nothing to disclose. Charles R. Wira has nothing to disclose. Charles Matouk has nothing to disclose. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Zoll. Dr. Sheth has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for NControl. The institution of Dr. Sheth has received research support from Biogen. The institution of Dr. Sheth has received research support from Novartis. The institution of Dr. Sheth has received research support from Bard. The institution of Dr. Sheth has received research support from Hyperfine. Dr. Sheth has received intellectual property interests from a discovery or technology relating to health care. Dr. Petersen has received research support from NIH.