Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome

Research output: Contribution to journalArticle

Eva A. Mistry, Akshitkumar M. Mistry, Mohammad Obadah Nakawah, Nicolas K. Khattar, Enzo M. Fortuny, Aurora S. Cruz, Michael T. Froehler, Rohan V. Chitale, Robert F. James, Matthew R. Fusco, John J. Volpi

Background- Current guidelines suggest treating blood pressure above 180/105 mm Hg during the first 24 hours in patients with acute ischemic stroke undergoing any form of recanalization therapy. Currently, no studies exist to guide blood pressure management in patients with stroke treated specifically with mechanical thrombectomy. We aimed to determine the association between blood pressure parameters within the first 24 hours after mechanical thrombectomy and patient outcomes. Methods and Results- We retrospectively studied a consecutive sample of adult patients who underwent mechanical thrombectomy for acute ischemic stroke of the anterior cerebral circulation at 3 institutions from March 2015 to October 2016. We collected the values of maximum, minimum, and average values of systolic blood pressure, diastolic blood pressure, and mean arterial pressures in the first 24 hours after mechanical thrombectomy. Primary and secondary outcomes were patients' functional status at 90 days measured on the modified Rankin scale and the incidence and severity of intracranial hemorrhages within 48 hours. Associations were explored using an ordered multivariable logistic regression analyses. A total of 228 patients were included (mean age 65.8±14.3; 104 males, 45.6%). Maximum systolic blood pressure independently correlated with a worse 90- day modified Rankin scale and hemorrhagic complications within 48 hours (adjusted odds ratio=1.02 [1.01-1.03], P=0.004; 1.02 [1.01-1.04], P=0.002; respectively) in multivariable analyses, after adjusting for several possible confounders. Conclusions- Higher peak values of systolic blood pressure independently correlated with worse 90-day modified Rankin scale and a higher rate of hemorrhagic complications. Further prospective studies are warranted to identify whether systolic blood pressure is a therapeutic target to improve outcomes.

Original languageEnglish (US)
Article numbere006167
JournalJournal of the American Heart Association
Volume6
Issue number5
DOIs
StatePublished - May 1 2017

PMID: 28522673

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Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome. / Mistry, Eva A.; Mistry, Akshitkumar M.; Nakawah, Mohammad Obadah; Khattar, Nicolas K.; Fortuny, Enzo M.; Cruz, Aurora S.; Froehler, Michael T.; Chitale, Rohan V.; James, Robert F.; Fusco, Matthew R.; Volpi, John J.

In: Journal of the American Heart Association, Vol. 6, No. 5, e006167, 01.05.2017.

Research output: Contribution to journalArticle

Harvard

Mistry, EA, Mistry, AM, Nakawah, MO, Khattar, NK, Fortuny, EM, Cruz, AS, Froehler, MT, Chitale, RV, James, RF, Fusco, MR & Volpi, JJ 2017, 'Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome' Journal of the American Heart Association, vol. 6, no. 5, e006167. https://doi.org/10.1161/JAHA.117.006167

APA

Mistry, E. A., Mistry, A. M., Nakawah, M. O., Khattar, N. K., Fortuny, E. M., Cruz, A. S., ... Volpi, J. J. (2017). Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome. Journal of the American Heart Association, 6(5), [e006167]. https://doi.org/10.1161/JAHA.117.006167

Vancouver

Mistry EA, Mistry AM, Nakawah MO, Khattar NK, Fortuny EM, Cruz AS et al. Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome. Journal of the American Heart Association. 2017 May 1;6(5). e006167. https://doi.org/10.1161/JAHA.117.006167

Author

Mistry, Eva A. ; Mistry, Akshitkumar M. ; Nakawah, Mohammad Obadah ; Khattar, Nicolas K. ; Fortuny, Enzo M. ; Cruz, Aurora S. ; Froehler, Michael T. ; Chitale, Rohan V. ; James, Robert F. ; Fusco, Matthew R. ; Volpi, John J. / Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome. In: Journal of the American Heart Association. 2017 ; Vol. 6, No. 5.

BibTeX

@article{762f6ba01b27429694a4c0d0aedbded8,
title = "Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome",
abstract = "Background- Current guidelines suggest treating blood pressure above 180/105 mm Hg during the first 24 hours in patients with acute ischemic stroke undergoing any form of recanalization therapy. Currently, no studies exist to guide blood pressure management in patients with stroke treated specifically with mechanical thrombectomy. We aimed to determine the association between blood pressure parameters within the first 24 hours after mechanical thrombectomy and patient outcomes. Methods and Results- We retrospectively studied a consecutive sample of adult patients who underwent mechanical thrombectomy for acute ischemic stroke of the anterior cerebral circulation at 3 institutions from March 2015 to October 2016. We collected the values of maximum, minimum, and average values of systolic blood pressure, diastolic blood pressure, and mean arterial pressures in the first 24 hours after mechanical thrombectomy. Primary and secondary outcomes were patients' functional status at 90 days measured on the modified Rankin scale and the incidence and severity of intracranial hemorrhages within 48 hours. Associations were explored using an ordered multivariable logistic regression analyses. A total of 228 patients were included (mean age 65.8±14.3; 104 males, 45.6{\%}). Maximum systolic blood pressure independently correlated with a worse 90- day modified Rankin scale and hemorrhagic complications within 48 hours (adjusted odds ratio=1.02 [1.01-1.03], P=0.004; 1.02 [1.01-1.04], P=0.002; respectively) in multivariable analyses, after adjusting for several possible confounders. Conclusions- Higher peak values of systolic blood pressure independently correlated with worse 90-day modified Rankin scale and a higher rate of hemorrhagic complications. Further prospective studies are warranted to identify whether systolic blood pressure is a therapeutic target to improve outcomes.",
keywords = "Blood pressure, Hemorrhage, Outcome, Stroke, Thrombectomy",
author = "Mistry, {Eva A.} and Mistry, {Akshitkumar M.} and Nakawah, {Mohammad Obadah} and Khattar, {Nicolas K.} and Fortuny, {Enzo M.} and Cruz, {Aurora S.} and Froehler, {Michael T.} and Chitale, {Rohan V.} and James, {Robert F.} and Fusco, {Matthew R.} and Volpi, {John J.}",
year = "2017",
month = "5",
day = "1",
doi = "10.1161/JAHA.117.006167",
language = "English (US)",
volume = "6",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley",
number = "5",

}

RIS

TY - JOUR

T1 - Systolic blood pressure within 24 hours after thrombectomy for acute Ischemic stroke correlates with outcome

AU - Mistry, Eva A.

AU - Mistry, Akshitkumar M.

AU - Nakawah, Mohammad Obadah

AU - Khattar, Nicolas K.

AU - Fortuny, Enzo M.

AU - Cruz, Aurora S.

AU - Froehler, Michael T.

AU - Chitale, Rohan V.

AU - James, Robert F.

AU - Fusco, Matthew R.

AU - Volpi, John J.

PY - 2017/5/1

Y1 - 2017/5/1

N2 - Background- Current guidelines suggest treating blood pressure above 180/105 mm Hg during the first 24 hours in patients with acute ischemic stroke undergoing any form of recanalization therapy. Currently, no studies exist to guide blood pressure management in patients with stroke treated specifically with mechanical thrombectomy. We aimed to determine the association between blood pressure parameters within the first 24 hours after mechanical thrombectomy and patient outcomes. Methods and Results- We retrospectively studied a consecutive sample of adult patients who underwent mechanical thrombectomy for acute ischemic stroke of the anterior cerebral circulation at 3 institutions from March 2015 to October 2016. We collected the values of maximum, minimum, and average values of systolic blood pressure, diastolic blood pressure, and mean arterial pressures in the first 24 hours after mechanical thrombectomy. Primary and secondary outcomes were patients' functional status at 90 days measured on the modified Rankin scale and the incidence and severity of intracranial hemorrhages within 48 hours. Associations were explored using an ordered multivariable logistic regression analyses. A total of 228 patients were included (mean age 65.8±14.3; 104 males, 45.6%). Maximum systolic blood pressure independently correlated with a worse 90- day modified Rankin scale and hemorrhagic complications within 48 hours (adjusted odds ratio=1.02 [1.01-1.03], P=0.004; 1.02 [1.01-1.04], P=0.002; respectively) in multivariable analyses, after adjusting for several possible confounders. Conclusions- Higher peak values of systolic blood pressure independently correlated with worse 90-day modified Rankin scale and a higher rate of hemorrhagic complications. Further prospective studies are warranted to identify whether systolic blood pressure is a therapeutic target to improve outcomes.

AB - Background- Current guidelines suggest treating blood pressure above 180/105 mm Hg during the first 24 hours in patients with acute ischemic stroke undergoing any form of recanalization therapy. Currently, no studies exist to guide blood pressure management in patients with stroke treated specifically with mechanical thrombectomy. We aimed to determine the association between blood pressure parameters within the first 24 hours after mechanical thrombectomy and patient outcomes. Methods and Results- We retrospectively studied a consecutive sample of adult patients who underwent mechanical thrombectomy for acute ischemic stroke of the anterior cerebral circulation at 3 institutions from March 2015 to October 2016. We collected the values of maximum, minimum, and average values of systolic blood pressure, diastolic blood pressure, and mean arterial pressures in the first 24 hours after mechanical thrombectomy. Primary and secondary outcomes were patients' functional status at 90 days measured on the modified Rankin scale and the incidence and severity of intracranial hemorrhages within 48 hours. Associations were explored using an ordered multivariable logistic regression analyses. A total of 228 patients were included (mean age 65.8±14.3; 104 males, 45.6%). Maximum systolic blood pressure independently correlated with a worse 90- day modified Rankin scale and hemorrhagic complications within 48 hours (adjusted odds ratio=1.02 [1.01-1.03], P=0.004; 1.02 [1.01-1.04], P=0.002; respectively) in multivariable analyses, after adjusting for several possible confounders. Conclusions- Higher peak values of systolic blood pressure independently correlated with worse 90-day modified Rankin scale and a higher rate of hemorrhagic complications. Further prospective studies are warranted to identify whether systolic blood pressure is a therapeutic target to improve outcomes.

KW - Blood pressure

KW - Hemorrhage

KW - Outcome

KW - Stroke

KW - Thrombectomy

UR - http://www.scopus.com/inward/record.url?scp=85019372668&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019372668&partnerID=8YFLogxK

U2 - 10.1161/JAHA.117.006167

DO - 10.1161/JAHA.117.006167

M3 - Article

VL - 6

JO - Journal of the American Heart Association

T2 - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 5

M1 - e006167

ER -

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