Abstract
Objectives
To evaluate the association between post-endovascular thrombectomy (EVT) blood-brain
barrier (BBB) disruption on MRI or CT and average systolic blood pressure (SBP) with
favorable 90-day functional outcome. Observational studies have found elevated SBP
associated with worse outcomes post-EVT, while recent randomized trials found no difference
in targeted BP reduction. There may be a subgroup of patients who benefit from targeted
BP reduction post-EVT.
Methods
This is a single-center study of 1) anterior large vessel occlusion stroke patients
treated with EVT from 2015 to 2021, 2) achieved mTICI grade 2b or 3. Hyperintense
acute reperfusion marker (HARM), hemorrhagic transformation (HT), and midline shift
at 3 h post-EVT and 24 h imaging were assessed independently by multiple raters. Binary
logistic regression models were used to determine the association of post-EVT SBP
with outcomes. BBB disruption was defined as HT or HARM on 3h post-EVT imaging.
Results
Of 103 patients, those with SBP 100-129 versus SBP 130-160 found no significant difference
in favorable 90-day outcome (64% vs. 46%, OR 2.11, 95% CI 0.78-5.76, p=0.143). However,
among 71 patients with BBB disruption, a significant difference in favorable outcome
of 64% in SBP 100-129 vs. 39% in SBP 130-160 group (OR 5.93, 95% CI 1.50-23.45, p=0.011)
was found. There was no difference in symptomatic ICH, 90-day mortality, midline shift
(≥5 mm), and hemicraniectomy, between BP or BBB groups.
Conclusions
BBB disruption on 3h post-EVT imaging and lower SBP was associated with favorable
outcome. This imaging finding may guide targeted BP therapy and suggests need for
a randomized control trial.
Keywords
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Article info
Publication history
Published online: November 23, 2022
Accepted:
October 24,
2022
Received in revised form:
October 10,
2022
Received:
August 10,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106870
Copyright
Published by Elsevier Inc.
