Master Theses UMCG - University of Groningen
English | Nederlands

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.

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