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Objective To investigate the effects of blood pressure variability (BPV) during thrombectomy on functional outcomes and hemorrhagic transformation for anterior circulation stroke. Methods We enrolled 116 patients with acute ischemic stroke due to large-vessel occlusion who received endovascular therapy in Department of Neurology of Hangzhou First People′s Hospital from October 2015 to August 2018 and analyzed their blood pressure (BP) records during thrombectomy. We calculated BPV: maximum (max), minimum (min), mean, range, standard deviation (SD), coefficient variation (CV) of systolic (SBP) and diastolic BP (DBP). Functional outcomes were evaluated using modified Rankin Scale (mRS) score in 90 d after surgery. Other outcomes were hemorrhagic infarction (HI), parenchymal hemorrhage (PH) and symptomatic intracerebral hemorrhage (sICH). Results Among the total 116 enrolled patients, 72 patients (62.1%) achieved good outcome. Forty-four patients (37.9%) developed hemorrhagic transformation (HT), among whom 27 were identified with HI and 17 with PH. Nine patients (7.8%) deteriorated to sICH. Multivariate regression analysis showed that larger intraoperative SBP range (OR=0.976, 95%CI: 0.943~0.992, P=0.010) and higher SBP CV (OR=0.903, 95%CI: 0.823~0.992, P=0.033), and DBP range (OR=0.937, 95%CI: 0.894~0.985, P=0.01) and DBP CV (OR=0.873, 95%CI: 0.785~0.970, P=0.012) were positively correlated with long-term adverse prognosis. While higher intraoperative maximum SBP (OR=1.037, 95%CI: 1.005~1.070, P=0.024) and DBP (OR=1.088, 95%CI: 1.031~1.148, P=0.002) and mean SBP (OR=1.051, 95%CI: 1.013~1.091, P=0.009) and mean DBP (OR=1.116, 95%CI: 1.041~1.196, P=0.002) had positive correlation with HI. Conclusion For the patients with acute ischemic stroke due to large-vessel occlusion, the greater the blood pressure variation during endovascular therapy, the worse the long-term prognosis, and the higher the incidence of postoperative HI. It is essential for intraoperative BP control during thrombectomy. |
