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High Systolic Blood Pressure after Successful Endovascular Treatment Affects Early Functional Outcome in Acute Ischemic Stroke.

Abstract Endovascular treatment (EVT) has been shown to significantly improve functional outcome in patients with acute large cerebral vessel occlusions. To date, no evidence-based recommendations on blood pressure management after successful EVT exist. Previous studies showed an association between high pre-EVT systolic blood pressure (SBP) and functional outcome, but do not answer the question on how to manage blood pressure after successful recanalization. The purpose of this study was to determine the role of blood pressure measurements as a predictor for early functional outcome in patients with successful EVT.
PMID
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Authors

Mayor MeshTerms
Keywords

Endovascular treatment

Ischemic stroke

Outcome

Systolic blood pressure

Journal Title cerebrovascular diseases (basel, switzerland)
Publication Year Start




PMID- 29176326
OWN - NLM
STAT- Publisher
LR  - 20171127
IS  - 1421-9786 (Electronic)
IS  - 1015-9770 (Linking)
VI  - 45
IP  - 1-2
DP  - 2017 Nov 24
TI  - High Systolic Blood Pressure after Successful Endovascular Treatment Affects
      Early Functional Outcome in Acute Ischemic Stroke.
PG  - 18-25
LID - 10.1159/000484720 [doi]
AB  - BACKGROUND: Endovascular treatment (EVT) has been shown to significantly improve 
      functional outcome in patients with acute large cerebral vessel occlusions. To
      date, no evidence-based recommendations on blood pressure management after
      successful EVT exist. Previous studies showed an association between high pre-EVT
      systolic blood pressure (SBP) and functional outcome, but do not answer the
      question on how to manage blood pressure after successful recanalization. The
      purpose of this study was to determine the role of blood pressure measurements as
      a predictor for early functional outcome in patients with successful EVT.
      METHODS: Prospectively derived data from patients with acute large vessel
      occlusion within the anterior circulation and EVT was analyzed in this
      monocentric study. Mean systolic- and maximum SBP as well as SBP-peaks have been 
      obtained for the first 24 h after successful EVT. Predictive value of SBP for
      discharge modified Rankin Scale (mRS) </=2 has been investigated using logistic
      regression models. RESULTS: From 168 patients with successful EVT, 74 (44%) had a
      favorable outcome with an mRS </=2. Mean- (127 vs. 131 mm Hg, p = 0.035) and
      maximum SBP (157 vs. 169 mm Hg, p < 0.001) as well as the number of SBP-peaks (0 
      vs. 1.5, p = 0.004) were lower in patients with favorable outcomes. Multivariable
      logistic regression showed high mean- and maximum SBP to predict unfavorable
      outcomes. Cutoff mean SBP was 141 mm Hg and maximum SBP 159 mm Hg. CONCLUSIONS:
      High SBP in the first 24 h after recanalization of acute anterior cerebral vessel
      occlusions is associated with unfavorable functional outcome. Interventional
      studies are needed to determine the role of SBP management as a modifiable
      parameter in the early phase after successful EVT.
CI  - (c) 2017 S. Karger AG, Basel.
FAU - Maier, Ilko L
AU  - Maier IL
AD  - Department of Neurology, University Medical Center Gottingen, Gottingen, Germany.
FAU - Tsogkas, Ioannis
AU  - Tsogkas I
AD  - Department of Neuroradiology, University Medical Center Gottingen, Gottingen,
      Germany.
FAU - Behme, Daniel
AU  - Behme D
AD  - Department of Neuroradiology, University Medical Center Gottingen, Gottingen,
      Germany.
FAU - Bahr, Mathias
AU  - Bahr M
AD  - Department of Neurology, University Medical Center Gottingen, Gottingen, Germany.
FAU - Knauth, Michael
AU  - Knauth M
AD  - Department of Neuroradiology, University Medical Center Gottingen, Gottingen,
      Germany.
FAU - Psychogios, Marios-Nikos
AU  - Psychogios MN
AD  - Department of Neuroradiology, University Medical Center Gottingen, Gottingen,
      Germany.
FAU - Liman, Jan
AU  - Liman J
AD  - Department of Neurology, University Medical Center Gottingen, Gottingen, Germany.
LA  - eng
PT  - Journal Article
DEP - 20171124
PL  - Switzerland
TA  - Cerebrovasc Dis
JT  - Cerebrovascular diseases (Basel, Switzerland)
JID - 9100851
OTO - NOTNLM
OT  - Endovascular treatment
OT  - Ischemic stroke
OT  - Outcome
OT  - Systolic blood pressure
EDAT- 2017/11/28 06:00
MHDA- 2017/11/28 06:00
CRDT- 2017/11/28 06:00
PHST- 2017/07/18 00:00 [received]
PHST- 2017/10/25 00:00 [accepted]
PHST- 2017/11/28 06:00 [entrez]
PHST- 2017/11/28 06:00 [pubmed]
PHST- 2017/11/28 06:00 [medline]
AID - 000484720 [pii]
AID - 10.1159/000484720 [doi]
PST - aheadofprint
SO  - Cerebrovasc Dis. 2017 Nov 24;45(1-2):18-25. doi: 10.1159/000484720.