Correlation And Predictive Ability Of Blood Pressure And Adverse Outcomes After Mechanical Thrombectomy For Acute Ischemic Cerebral Infarction

ObjectiveTo investigate the effects of 24 h blood pressure（BP）and blood pressure variability（BPV）after Mechanical thrombectomy（MT）in acute large vessel occlusive stroke（ALVOS）on 90-day functional prognosis,death within 90 days,intracranial hemorrhage conversion（HT）and symptomatic intracranial hemorrhage（s ICH）.MethodsFrom March 2017 to November 2020,a total of 114 patients who were admitted to Jiangxi Provincial People’s Hospital and the First Affiliated Hospital of Nanchang University and confirmed as ALVOS by imaging and had undergone MT and preoperative magnetic resonance imaging（MRI）examination were collected.The modified Rankin Scale（m RS）score was used as the prognostic index.The score of good prognosis was 0-2,and that of poor prognosis was 3-6.Death within 90 days is all-cause death.HT refers to any form of hemorrhage confirmed by imaging within24 hours.According to ECASS standard,Sich is defined as hemorrhage in any part of brain parenchyma,subarachnoid space and ventricle within 24-36 hours after operation,and the NIHSS score is increased by more than 4 points.The baseline data and blood pressure related data of 90 day functional prognosis group and poor prognosis group,90 day death group and survival group,with or without s ICH and HT were compared.Whether the blood pressure and blood pressure fluctuation related indicators within 24 hours after operation were related to the outcome indicators and whether they were independent risk factors for the outcome indicators were analyzed.ResultsA total of 114 patients with an average age of 66.5 years were enrolled,including 68 males（59.6%）.The median time of onset was 300 minutes,the median NIHSS score was 17 points,104 patients（92.1%）were completely recanalized,54patients（47.4%）had a good prognosis within 90 days,60 patients（52.6%）had a poor prognosis,30 patients（26.3%）died within 90 days,17 patients（14.9%）had s ICH,and 49 patients（43%）had HT.In univariate analysis,there were no significant differences in the maximum mean arterial pressure(MAP_max),the minimum mean arterial pressure(MAP_min),the mean arterial pressure(MAP_mean),the difference between the mean arterial pressure within 24 hours after operation and the mean arterial pressure at admission（ΔMAP）between the two groups,but the mean arterial pressure range(MAP_range,32.67mm Hgvs26.17mm Hg,P<0.01)of the poor prognosis group was not significantly different The mean arterial pressure standard deviation(MAP_SD,8.1 vs6.39,P=0.01),mean arterial pressure coefficient of variation(MAP_CV,0.1 vs 0.08,P=0.02),mean arterial pressure continuous variation(MAP_SV,7.9 vs 7.14,P=0.03)and mean independent variation(MAP_VIM,0.09 vs 0.07,P=0.02)were higher than those in the good prognosis group It is suggested that MAP_range（OR=1.08,95%CI:1.02-1.13,P<0.01）,MAP_SD（OR=1.32,95%CI:1.08-1.61,P<0.01）,MAP_CV（OR=1.21,95%CI:1.02-1.44,P=0.03）,MAP_SV（OR=1.21,95%CI:1.03-1.45,P=0.02）and MAP_VIM（OR=1.25,95%CI:1.08-1.45,P<0.01）may still be used as independent predictors of 90 day functional prognosis The area under the curve was0.64（3）,and the best cutoff value was 27.17mm Hg.In 90 day survival group and death group,patients who died within 90 days had higher MAP_max（109.17mm Hg vs 103.34mm Hg,P<0.01）,MAP_mean（92.2mm Hg vs87.43mm Hg,P<0.01）and MAP_VIM（7.58vs6.67,P=0.03）,but there was no significant difference in MAP_min,MAP_range,MAP_SD,MAP_CV,MAPsv andΔMAP.After adjusting for confounding factors,it was found that MAP_max,MAP_meanand MAP_VIMcould be used as risk factors For each 1 mm Hg increase in MAP_max,the risk of death increased by 7%（OR=1.07,95%CI:1.02-1.12,<0.01）;for each 0.01increase in MAP_VIM,the risk of death increased by 14%（OR=1.14,95%CI:1.01-1.3,P=0.04）.After drawing the ROC curve,it is found that MAP_maxhas the largest area under the curve of 0.68,and the best cutoff value is 107.5mm Hg.In the comparison of s ICH with or without,only DWI estimate in baseline data was different,and MAP_range,MAP_SD,MAP_CVand MAPsv in blood pressure indexes were significantly different.Unfortunately,after adjusting for confounding factors,only MAPsv（OR=1.25,95%CI:1-1.56,P<0.05）could be used as an independent predictor of s ICH.There was no difference in blood pressure between the two groups when comparing the presence or absence of HT.ConclusionsIn patients with ALVOS,blood pressure and blood pressure variation within 24hours after MT can affect 90 day prognosis and 90 day mortality in varying degrees,and increase the incidence of s ICH.Although the current target of blood pressure control may greatly reduce the incidence of adverse outcomes,we still need to increase the management of blood pressure variation on the basis of target blood pressure in the future.