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Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study
Author(s) -
Anadani Mohammad,
Arthur Adam S.,
Tsivgoulis Georgios,
Simpson Kit N.,
Alawieh Ali,
Orabi Yser,
Goyal Nitin,
Alexandrov Andrei V.,
Maier Ilko L.,
Psychogios MariosNikos,
Liman Jan,
Brinton Daniel,
Swisher Christa B.,
Shah Shreyash,
Inamullah Ovais,
Keyrouz Salah,
Kansagra Akash P.,
Allen Michelle,
Giles James A.,
Wolfe Stacey Q.,
Fargen Kyle M.,
Gory Benjamin,
De Marini Pierre,
Kan Peter,
Nascimento Fábio A.,
Almallouhi Eyad,
Petersen Nils,
Kodali Sreeja,
Rahman Shareena,
Richard Sébastien,
Spiotta Alejandro M.
Publication year - 2020
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25716
Subject(s) - medicine , odds ratio , odds , revascularization , thrombolysis , cardiology , blood pressure , subgroup analysis , meta analysis , logistic regression , myocardial infarction
Objective Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SBP goals after EVT with SR. Methods This international multicenter study included 8 comprehensive stroke centers and patients with anterior circulation large vessel occlusion who were treated with EVT and achieved SR. SR was defined as modified thrombolysis in cerebral ischemia 2b to 3. Patients were divided into 3 groups based on SBP goal in the first 24 hours after EVT. Inverse probability of treatment weighting (IPTW) propensity analysis was used to assess the effect of different SBP goals on clinical outcomes. Results A total of 1,019 patients were included. On IPTW analysis, the SBP goal of <140mmHg was associated with a higher likelihood of good functional outcome and lower odds of hemicraniectomy compared to SBP goal of <180mmHg. Similarly, SBP goal of <160mmHg was associated with lower odds of mortality compared to SBP goal of <180mmHg. In subgroup analysis including only patients with pre‐EVT SBP of ≥140mmHg, an SBP of <140mmHg was associated with a higher likelihood of good functional outcome, lower odds of symptomatic intracranial hemorrhage, and lower odds of requirement for hemicraniectomy compared to SBP goal of <180mmHg. Interpretation SBP goals of <140 and < 160mmHg following SR with EVT appear to be associated with better clinical outcomes than SBP of <180mmHg. ANN NEUROL 2020;87:830–839