Association of intensive blood pressure lowering after endovascular thrombectomy with outcomes according to contrast staining ASPECTS.
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Jung Jae Wook, Kim Young Dae, Heo JoonNyung, Lee Hyungwoo, Kim Byungjae, Kim Byung Moon, Kim Dong Joon, Shin Na-Young, Joo Haram, Cho Bang-Hoon, Ahn Seong Hwan, Park Hyungjong, Sohn Sung-Il, Hong Jeong-Ho, Yun Jaeseob, Song Tae-Jin, Chang Yoonkyung, Kim Gyu Sik, Chang Jun Young, Seo Jung Hwa, Lee Sukyoon, Baek Jang-Hyun, Cho Han Jin, Shin Dong Hun, Kim Jinkwon, Yoo Joonsang, Baik Minyoul, Jung Yo Han, Seo Kwon-Duk, Hwang Yang-Ha, Kim Chi Kyung, Kim Jae Guk, Lee Il Hyung, Choi Jin Kyo, Jeon Soyoung, Lee Hye Sun, Kim Kwang Hyun, Kwon Sun U, Bang Oh Young, Heo Ji Hoe, Nam Hyo Suk
Аннотация
METHODS: This post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure trial included acute stroke patients who achieved successful EVT and underwent follow-up brain CT within 3 hours of randomisation to intensive (systolic BP <140 mm Hg) or conventional (140-180 mm Hg) BP management. Subgroup analyses were conducted based on CS status and CS-ASPECTS.
RESULTS: Among 174 patients (mean age 72.8±12.1 years, 38.5% women), CS was present in 123 (70.7%). CS was associated with a higher rate of any intracranial haemorrhage (ICH) but not with functional outcome. CS-ASPECTS 0-6 was associated with a higher risk of symptomatic ICH and worse functional outcome compared with CS-ASPECTS 7-10. Among patients with CS-ASPECTS 7-10, intensive BP lowering was associated with a lower likelihood of functional independence (adjusted OR 0.37, 95% CI 0.15 to 0.87), whereas no significant association was observed in patients with CS-ASPECTS 0-6 (adjusted OR 1.29, 95% CI 0.20 to 9.09) (P for interaction=0.044). There was no significant heterogeneity between BP management strategy and CS-ASPECTS for symptomatic intracerebral haemorrhage or mortality.
CONCLUSIONS: CS-ASPECTS, but not CS alone, was associated with functional outcome and identified heterogeneity in the association between post-EVT BP lowering and functional independence. These exploratory findings warrant prospective validation before clinical application.
TRIAL REGISTRATION NUMBER: NCT04205305.