Journal of clinical anesthesia · 2024
Clinical outcome after endovascular stroke Thrombectomy: Association with pre-reperfusion blood pressure.
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Ranft Andreas, Berger Sebastian, Schubert Martin, Wunderlich Silke, Boeckh-Behrens Tobias, Schneider Gerhard, Hapfelmeier Alexander
Аннотация
STUDY OBJECTIVE: Blood pressure drops during endovascular treatment of acute ischemic stroke have been associated with worse outcomes for stroke patients. We aimed to evaluate this observation in our patient population.
DESIGN: Retrospective study.
SETTING: University hospital.
PATIENTS: Records from patients who underwent endovascular treatment of acute ischaemic stroke under general anaesthesia at a university hospital from 2017 to 2020 were screened. 586 patients aged 78 years (interquartile range [IQR] 67-84) with a mean National Institutes of Health Stroke Scale score of 15 (IQR 8-19) were included.
INTERVENTIONS: None.
MEASUREMENTS: Good functional outcome was defined as a three-month modified Rankin Scale (mRS) value between 0 and 2, or a mRS value less than or equal to the pre-stroke baseline.
MAIN RESULTS: In addition to well-established predictors, blood pressure before reperfusion was found to be associated with good functional outcomes. Per five minutes that systolic arterial pressure spent below 140 mmHg, the odds of good outcome decreased by 11.1 %.
CONCLUSIONS: In this retrospective study of general anaesthesia for endovascular stroke therapy, blood pressure drops during the intervention were associated with reduced odds of a good functional outcome three months later. Before a clinical recommendation can be made, a prospective study must clarify effective and safe target ranges of blood pressure support and augmentation.
DESIGN: Retrospective study.
SETTING: University hospital.
PATIENTS: Records from patients who underwent endovascular treatment of acute ischaemic stroke under general anaesthesia at a university hospital from 2017 to 2020 were screened. 586 patients aged 78 years (interquartile range [IQR] 67-84) with a mean National Institutes of Health Stroke Scale score of 15 (IQR 8-19) were included.
INTERVENTIONS: None.
MEASUREMENTS: Good functional outcome was defined as a three-month modified Rankin Scale (mRS) value between 0 and 2, or a mRS value less than or equal to the pre-stroke baseline.
MAIN RESULTS: In addition to well-established predictors, blood pressure before reperfusion was found to be associated with good functional outcomes. Per five minutes that systolic arterial pressure spent below 140 mmHg, the odds of good outcome decreased by 11.1 %.
CONCLUSIONS: In this retrospective study of general anaesthesia for endovascular stroke therapy, blood pressure drops during the intervention were associated with reduced odds of a good functional outcome three months later. Before a clinical recommendation can be made, a prospective study must clarify effective and safe target ranges of blood pressure support and augmentation.