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The prognostic value of blood pressure variation during intra-arterial thrombectomy for acute ischemic stroke

(2018) Collette, S.L.

Background: Intra-arterial thrombectomy (IAT) has significantly improved the prognosis of acute ischemic stroke due to proximal occlusion. Whether the intervention should be performed under general anesthesia (GA) or local anesthesia (LA) is a matter of debate, since several studies and meta-analyses show conflicting results in clinical outcome.
Aim: To determine whether GA-induced blood pressure variation during IAT is associated with postprocedural clinical outcome at 90 days.
Methods: In this double-center retrospective observational study, periprocedural systolic and diastolic blood pressures from patients with a proximal occlusion of the anterior circulation were collected. To summarize the extent and duration of blood pressure variation, area under the threshold (AUT) was calculated. Hypotension was predefined as a mean arterial pressure (MAP) <70 mm Hg. After adjusting for confounders, multiple ordinal logistic regression analyses were performed to investigate associations between functional outcome and AUT, the occurrence of hypotension, hypotension frequency, and hypotension duration. Functional outcome was measured with modified Ranking Scale (mRS).
Results: Data from 367 patients who underwent IAT between December 2008 and December 2017, were analyzed. For each mm Hg*min AUT the chance of poor clinical outcome increased (adjusted odds ratio (aOR): 0.999; 95% confidence interval (CI): 0.998-1.001). Periprocedural hypotension as well as hypotension frequency were associated with poor outcome (aOR: 0.60; 95% CI: 0.40-0.92 respectively aOR: 0.85; 95% CI: 0.73-0.99).
Conclusion: Quantitative measurement of depth of hypotension and duration were not predictive of postprocedural mRS in patients who underwent IAT under GA due to acute ischemic stroke. However, periprocedural hypotension and increased hypotension frequency were associated with poor clinical outcome.





ID 3876
Moeder ID 3802
Volgorde Collette, S.L.
Naam ColletteSL
Publiceren yes
OAI-naam Student_thesis
Path root/geneeskunde/2018/ColletteSL/
Gemaakt op: 2019-01-21 08:22:06
Gemodificeerd op: 2019-01-21 08:22:06
Digitaal ID 5c45812cf0d3a
Afstudeerrichting opleiding/afstudeerrichting 1
Studierichting Studierichting 1
Titel The prognostic value of blood pressure variation during intra-arterial thrombectomy for acute ischemic stroke
Ruilverkeer mogelijk no
Printen in opdracht no
Aantal pagina's 27
Publicatiejaar 2018
Taal nl
Engelse samenvatting Background: Intra-arterial thrombectomy (IAT) has significantly improved the prognosis of acute ischemic stroke due to proximal occlusion. Whether the intervention should be performed under general anesthesia (GA) or local anesthesia (LA) is a matter of debate, since several studies and meta-analyses show conflicting results in clinical outcome.
Aim: To determine whether GA-induced blood pressure variation during IAT is associated with postprocedural clinical outcome at 90 days.
Methods: In this double-center retrospective observational study, periprocedural systolic and diastolic blood pressures from patients with a proximal occlusion of the anterior circulation were collected. To summarize the extent and duration of blood pressure variation, area under the threshold (AUT) was calculated. Hypotension was predefined as a mean arterial pressure (MAP) <70 mm Hg. After adjusting for confounders, multiple ordinal logistic regression analyses were performed to investigate associations between functional outcome and AUT, the occurrence of hypotension, hypotension frequency, and hypotension duration. Functional outcome was measured with modified Ranking Scale (mRS).
Results: Data from 367 patients who underwent IAT between December 2008 and December 2017, were analyzed. For each mm Hg*min AUT the chance of poor clinical outcome increased (adjusted odds ratio (aOR): 0.999; 95% confidence interval (CI): 0.998-1.001). Periprocedural hypotension as well as hypotension frequency were associated with poor outcome (aOR: 0.60; 95% CI: 0.40-0.92 respectively aOR: 0.85; 95% CI: 0.73-0.99).
Conclusion: Quantitative measurement of depth of hypotension and duration were not predictive of postprocedural mRS in patients who underwent IAT under GA due to acute ischemic stroke. However, periprocedural hypotension and increased hypotension frequency were associated with poor clinical outcome.
Nederlandse samenvatting Achtergrond: Intra-arteriële trombectomie (IAT) heeft de prognose van acute ischemische herseninfarcten op basis van een proximale occlusie aanzienlijk verbeterd. Of de interventie het best onder narcose of lokale verdoving plaats kan vinden, is onduidelijk doordat studies tegenstrijdige klinische uitkomstresultaten laten zien.
Doel: Bepalen of narcose geïnduceerde bloeddrukvariatie tijdens IAT geassocieerd is met klinische uitkomst 90 dagen postprocedureel.
Methoden: In dit observationele retrospectieve onderzoek binnen twee universitaire medische centra, werden periprocedurele systolische en diastolische bloeddrukken van patiënten met een proximale occlusie in de anterieure circulatie verzameld. Diepte en duur van bloeddrukvariatie werden samengevat in een gebied onder de curve (AUT), waarbij hypotensie werd gedefinieerd als een gemiddelde arteriële bloeddruk (MAP) <70 mm Hg. Na correctie voor confounders werd met behulp van multipele ordinale logistische regressieanalyses associaties bepaald tussen functionele uitkomst en AUT, aanwezigheid van hypotensie, hypotensiefrequentie en -duur. Functionele uitkomst werd gemeten door middel van modified Rankin Scale (mRS).
Resultaten: Data van 367 patiënten, die tussen december 2008 en december 2017 een IAT hadden ondergaan, werden geanalyseerd. Bij elke mm Hg*min stijging in AUT nam de kans op slechte klinische uitkomst toe (geadjusteerde odds ratio (aOR): 0.999; 95%-betrouwbaarheidsinterval (BI): 0.998-1.001). Periprocedurele hypotensie en frequentie van hypotensie periodes waren geassocieerd met een slechte klinische uitkomst (aOR: 0.60; 95%-BI: 0.40-0.92 respectievelijk aOR: 0.85; 95%-BI: 0.73-0.99).
Conclusie: De combinatie van hypotensie diepte en duur was niet voorspellend voor postprocedurele mRS bij patiënten met een acuut herseninfarct, waarvoor een mechanische trombectomie onder algehele narcose werd verricht. Periprocedurele hypotensie en toegenomen hypotensie frequentie waren daarentegen wel geassocieerd met slechte klinische uitkomst.
Onderwijsinstelling Medical Sciences
Type embargo abstract openbaar, scriptie op aanvraag
Auteur(s) Collette, S.L.
UMCG begeleider(s) Uyttenboogaart, Dr. M.; Department of Neurology; The University Medical Center Groningen
Auteur(s) Collette, S.L.
UMCG begeleider(s) Uyttenboogaart, Dr. M.; Department of Neurology; The University Medical Center Groningen


 
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