A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes
A 10% blood pressure drop from baseline during mechanical thrombectomy for stroke is strongly associated with worse neurological outcomes
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DOI：
10.1136/neurintsurg-2019-015247
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发表时间：
2020-04-01
影响因子：
4.8
通讯作者：
Leguen, Morgan
中科院分区：
文献类型：
--
作者：
Valent, Arnaud;Sajadhoussen, Amard;Leguen, Morgan
背景：急性缺血性脑卒中的机械取栓术（MT）可以在局部麻醉、有意识镇静（CS）或全身麻醉（GA）下进行。麻醉药物的血流动力学后果可以解释为什么GA可能与较差的结果相关。我们评估了两种麻醉方案下MT期间低血压持续时间与90天功能结果之间的关系。方法本回顾性研究纳入在GA或CS下接受MT治疗的缺血性卒中患者。主要暴露变量为MT前动脉压低于参考值90%的时间。主要结局为功能不良，定义为90天修正Rankin评分>= 3。结果371例患者纳入研究。GA的发生率为42%。观察到动脉低血压持续时间与预后呈线性相关。在基线平均动脉压低于90%的情况下，10分钟功能不良结局的优势比为1.13 (95% CI 1.06 ~ 1.21)，未调整后的优势比为1.11 (95% CI 1.02 ~ 1.21)，校正混杂因素后的优势比为1.11。与CS相比，GA治疗的患者功能预后较差，但两种情况下与低血压深度的关联仍然相似。在这项研究中，我们观察到MT期间低血压持续时间与90天的功能结果之间存在线性关联。应考虑积极和个性化的低血压治疗策略。应该进行进一步的试验来解决这个问题。
BackgroundMechanical thrombectomy (MT) for acute ischemic stroke can be performed under local anesthesia, with or without conscious sedation (CS), or under general anesthesia (GA). The hemodynamic consequence of anesthetic drugs may explain why GA may be associated with worse outcomes. We evaluated the association between hypotension duration during MT and the 90 day functional outcome under both anesthetic regimens.MethodsPatients were included in this retrospective study if they had an ischemic stroke treated by MT under GA or CS. The main exposure variable was the time below 90% of the reference value of arterial pressure measured before MT. The primary outcome was poor functional outcome defined as a 90 day modified Rankin Score >= 3.Results371 patients were included in the study. GA was performed in 42%. A linear association between the duration of arterial hypotension and outcome was observed. The odds ratio for poor functional outcome of 10 min under 90% of the baseline mean arterial pressure was 1.13 (95% CI 1.06 to 1.21) without adjustment and 1.11 (95% CI 1.02 to 1.21) after adjustment for confounding factors. The functional outcome was poorer for patients treated under GA compared with CS, but the association with the depth of hypotension remained similar under both conditions.ConclusionIn this study, we observed a linear association between the duration of hypotension during MT and the functional outcome at 90 days. An aggressive and personalized strategy for the treatment of hypotension should be considered. Further trials should be conducted to address this question.