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Pre-endovascular therapy change in blood pressure is associated with outcomes in patients with stroke
  1. Eva A Mistry1,
  2. Katarina Dakay2,
  3. Nils H Petersen3,
  4. Mahesh Jayaraman4,
  5. Ryan McTaggart5,
  6. Karen Furie6,
  7. Akshitkumar Mistry7,
  8. Tapan Mehta8,
  9. Niraj Arora9,
  10. Felipe De Los Rios La Rosa10,
  11. Amy Kathryn Starosciak10,
  12. James E Siegler11,
  13. Natasha Barnhill12,
  14. Kishan Patel13,
  15. Salman Assad14,
  16. Amjad Tarboosh14,
  17. Aurora Seaton Cruz15,
  18. Jeffrey Wagner16,
  19. Enzo Fortuny15,
  20. Alicia Bennett16,
  21. Robert F James15,
  22. Bharathi Dasan Jagadeesan17,
  23. Christopher Streib8,
  24. Scott Kasner18,
  25. Stuart Weber12,
  26. Rohan V Chitale7,
  27. John Volpi13,
  28. Stephan A Mayer14,
  29. Pooja Khatri19,
  30. Shadi Yaghi20
  1. 1Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
  2. 2Neurosurgery, New York Medical College, Valhalla, New York, USA
  3. 3Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
  4. 4Neurology, Rhode Island Hospital, Providence, Rhode Island, USA
  5. 5Radiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
  6. 6Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
  7. 7Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  8. 8Neurology, University of Minnesota, Minneapolis, Minnesota, USA
  9. 9University of Missouri, Columbia, Missouri, USA
  10. 10Baptist Health Neuroscience Center, Miami, Florida, USA
  11. 11Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
  12. 12Oregon Health & Science University, Portland, Oregon, USA
  13. 13Neurology, Houston Methodist Hospital, Houston, Texas, USA
  14. 14Neurology, Henry Ford Hospital, Detroit, Michigan, USA
  15. 15Neurosurgery, University of Louisville, Louisville, Kentucky, USA
  16. 16Blue Sky Neurology, Englewood, Colorado, USA
  17. 17University of Minnesota, Minneapolis, Minnesota, USA
  18. 18Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  19. 19Neurology and Rehabilitation Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
  20. 20Neurology, NYU Langone Medical Center, New York, New York, USA
  1. Correspondence to Dr Eva A Mistry, Neurology & Rehabilitation Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, USA; esamin87{at}gmail.com

https://doi.org/10.1136/jnnp-2019-322534

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    Introduction

    The American Heart Association/American Stroke Association guideline recommends maintaining blood pressure (BP) below 185/110 mm Hg in acute stroke patients prior to initiating any form of reperfusion therapy.1 However, the evidence supporting this recommendation is not strong for patients undergoing endovascular treatment (EVT). Higher BP at presentation in these patients is associated with worse outcomes and haemorrhagic complications.2 However, BP-lowering prior to EVT for avoidance of hyperperfusion as well as induced hypertension for penumbral sustenance have been proposed to improve patient outcomes.2 3 Prior to further testing of these strategies, whether changes in BP in either direction prior to EVT are associated with functional outcomes needs to be assessed. Because any changes in pre-EVT BP may affect ultimate functional outcome through an effect on cerebral perfusion, we aimed to determine the association of the change in pre-EVT mean arterial BP (MAP) with 90-day functional outcomes.

    Methods

    We conducted a post-hoc analysis of the ‘Blood pressure after Endovascular Stroke Therapy (BEST)’ study, which prospectively enrolled consecutive adult patients treated with EVT for an anterior (Internal Carotid Artery/M1/M2) acute ischaemic stroke at 12 comprehensive stroke centres across the USA from November 2017 to May 2018.4

    Study variables included change in MAP from admission to immediately pre-EVT. MAP was calculated using the following formula: (2×diastolic BP+systolic BP)/3. The primary outcome was dichotomous 90-day modified Rankin score …

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    Footnotes

    • Twitter @katarinadakay

    • Contributors Conception and design of the study: EAM, KD, NHP, RM, KF, SK, PK, SY. Acquisition and analysis of data: EAM, KD, MJ, AM, TM, NA, FDLRLR, AKS, JES, NB, KP, SA, AT, ASC, JW, EF, AB, RFJ, BDJ, CS, SW, RVC, JV, SAM, SY. Drafting a significant portion of the manuscript or figure: EAM, KD, PK, SY.

    • Funding The study was funded by the Society of Vascular and Interventional Neurology, University of Cincinnati Gardner Neuroscience Institute, and NIH/NIHDS (K23NS113858).

    • Competing interests JES reports shares in Remedy Pharmaceuticals. RVC reports research grants from Medtronic and Cerenovus. JV reports personal fees from Amgen and Johnson & Johnson. SK reports research grants and consulting fees from Medtronic. BDJ reports consulting fees from MicroVention. MJ reports honoraria from Medtronic. PK reports research grant from Cerenovus.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by all institutional review boards except one that deemed it exempt. Patient consent was waived.

    • Provenance and peer review Not commissioned; externally peer reviewed.