Effect Of 24-hour Blood Pressure After Mechanical Thrombectomy On Prognosis Of Patients With Acute Ischemic Stroke

Objective: To investigate the effect of blood pressure level within 24-hour after mechanical thrombectomy on the prognosis of patients with acute large vessel occlusive ischemic stroke(AIS).Methods : 118 patients with acute large vessel occlusive stroke treated by mechanical thrombectomy in the cerebrovascular Department of our hospital from June 2019 to June 2021 were analyzed retrospectively.The basic information,past medical history,admission NIHSS score and relevant clinical data of each patient were recorded.24 h ambulatory blood pressure monitoring was carried out for patients after mechanical thrombectomy.The mean values of systolic blood pressure(SBP)and diastolic blood pressure(DBP)within 24 h after mechanical thrombectomy were collected,and the mean values of SBP and DBP,standard deviation(SD),coefficient of variation(CV)and continuous variation(SV)were calculated.Taking the 90 day prognosis Mrs score as the main outcome index and the symptomatic intracranial hemorrhage as the secondary outcome index,the correlation between blood pressure index and 90 day prognosis and bleeding transformation of AIS patients was discussed by univariate and multivariate logistic regression analysis.Modified thrombolysis in cerebral infarction(m TICI)was used to evaluate the recanalization of blood vessels after thrombectomy,and subgroup analysis was carried out according to the recanalization status.Results:(1)There was no significant correlation between baseline blood pressure at admission and functional outcome after mechanical thrombectomy(P >0.05);(2)Univariate logistic regression analysis of risk factors affecting the prognosis of AIS patients receiving mechanical thrombectomy found that the proportion of patients with lower mean SBP after mechanical thrombectomy had a better outcome(mean SBP,133 mm Hg vs 139 mm Hg,P = 0.010);(3)Multivariate logistic regression analysis showed that the continuous change of SBP variability index(OR,1.058,95% CI: 1.027-1.231,P = 0.027)and coefficient of variation(OR,1.013,95% CI: 1.004-1.216,P = 0.046)were independent risk factors for poor prognosis at 90 days after operation;The mean value of SBP(OR,1.113,95% CI: 1.005-1.257,P = 0.034)and continuous change of SBP(OR,1.834,95% CI: 1.647-2.274,P = 0.019)were significantly correlated with the occurrence of symptomatic intracranial hemorrhage.According to the subgroup analysis of recanalization status,in the successful recanalization group,the continuous change of SBP(OR: 1.361,95% CI: 1.094-1.691;P = 0.025)and the coefficient of variation of SBP(OR: 1.698,95% CI: 1.098-1.971;P = 0.018)were independent risk factors affecting the 90 day clinical prognosis of patients with mechanical thrombectomy.In patients who were not completely recanalized,no BP index was found to be related to the clinical prognosis 90 days after thrombectomy.Conclusions:(1)After recanalization of occluded vessels,the increased variability of SBP at 24-hour after mechanical thrombectomy was associated with poor prognosis at 90 d and symptomatic intracranial hemorrhage after operation;(2)After mechanical thrombectomy,early stable hypotension and SBP maintained at a slightly lower level of 140 mm Hg may have better clinical outcomes.