Hemodynamic Status During Endovascular Stroke Treatment: Association of Blood Pressure with Functional Outcome.
Hemodynamic Status During Endovascular Stroke Treatment: Association of Blood Pressure with Functional Outcome.
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DOI：
10.1007/s12028-021-01229-w
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发表时间：
2021-12
影响因子：
3.5
通讯作者：
Schönenberger S
中科院分区：
文献类型：
--
作者：
Chen M;Kronsteiner D;Pfaff J;Schieber S;Jäger L;Bendszus M;Kieser M;Möhlenbruch MA;Ringleb PA;Bösel J;Schönenberger S
大血管闭塞患者血管内卒中治疗期间的最佳血压（BP）管理尚未确立。我们旨在研究血管内治疗不同阶段的血压与再灌注和功能结局的关系。我们对一项单中心前瞻性研究进行了事后分析，该研究评价了血管内治疗期间新的简化手术镇静标准（继续评价血管内卒中治疗围介入期轻度镇静管理中的方案简化）。根据方案管理患者血管内治疗期间的血压。获得了四个不同阶段（基线、再通前、再通后和干预后）的数据，并将平均BP值以及不同阶段之间的BP变化以及基线至再通前的收缩压（SBP）和平均动脉压（MAP）降低作为暴露变量。主要结果是入院后3个月的改良兰金量表评分为0-2分。次要结局是成功再灌注和24小时后国立卫生研究院卒中量表评分的变化。采用多元线性回归和逻辑回归模型进行统计分析。分析了139例成功再灌注（定义为脑梗死2b-3级溶栓）患者的功能结局。平均（标准差）年龄为76（10.9）岁，平均（标准差）美国国立卫生研究院卒中量表评分为14.3（7.5），70（43.5%）例患者发生左侧血管闭塞。基线（比值比[OR] 0.76，P = 0.04）和再通前（OR 0.65，P = 0.011）SBP每增加10 mm Hg，有利的功能结局（改良兰金量表评分0-2分）的可能性较小。基线（OR 0.76，P = 0.05）和再通前MAP（OR 0.66，P = 0.03）也发现了这一点。接受者操作特征分析中的最大Youden指数显示，SBP为163 mm Hg，MAP为117 mm Hg是预再通阶段预测功能结局的判别阈值。在我们基于方案的环境中，血管内治疗期间术中再通前血压降低与功能结局无关。然而，较高的术中再通前SBP和MAP与较差的功能结局相关。需要前瞻性随机对照研究来确定BP是否是改变结局的可行治疗目标。在线版本包含补充材料，可通过10.1007/s12028-021-01229-w获得。
Optimal blood pressure (BP) management during endovascular stroke treatment in patients with large-vessel occlusion is not well established. We aimed to investigate associations of BP during different phases of endovascular therapy with reperfusion and functional outcome. We performed a post hoc analysis of a single-center prospective study that evaluated a new simplified procedural sedation standard during endovascular therapy (Keep Evaluating Protocol Simplification in Managing Periinterventional Light Sedation for Endovascular Stroke Treatment). BP during endovascular therapy in patients was managed according to protocol. Data from four different phases (baseline, pre-recanalization, post recanalization, and post intervention) were obtained, and mean BP values, as well as changes in BP between different phases and reductions in systolic BP (SBP) and mean arterial pressure (MAP) from baseline to pre-recanalization, were used as exposure variables. The main outcome was a modified Rankin Scale score of 0–2 three months after admission. Secondary outcomes were successful reperfusion and change in the National Institutes of Health Stroke Scale score after 24 h. Multivariable linear and logistic regression models were used for statistical analysis. Functional outcomes were analyzed in 139 patients with successful reperfusion (defined as thrombolysis in cerebral infarction grade 2b–3). The mean (standard deviation) age was 76 (10.9) years, the mean (standard deviation) National Institutes of Health Stroke Scale score was 14.3 (7.5), and 70 (43.5%) patients had a left-sided vessel occlusion. Favorable functional outcome (modified Rankin Scale score 0–2) was less likely with every 10-mm Hg increase in baseline (odds ratio [OR] 0.76, P = 0.04) and pre-recanalization (OR 0.65, P = 0.011) SBP. This was also found for baseline (OR 0.76, P = 0.05) and pre-recanalization MAP (OR 0.66, P = 0.03). The maximum Youden index in a receiver operating characteristics analysis revealed an SBP of 163 mm Hg and MAP of 117 mm Hg as discriminatory thresholds during the pre-recanalization phase to predict functional outcome. In our protocol-based setting, intraprocedural pre-recanalization BP reductions during endovascular therapy were not associated with functional outcome. However, higher intraprocedural pre-recanalization SBP and MAP were associated with worse functional outcome. Prospective randomized controlled studies are needed to determine whether BP is a feasible treatment target for the modification of outcomes. The online version contains supplementary material available at 10.1007/s12028-021-01229-w.
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8.3
作者：
Liebeskind DS;Jahan R;Nogueira RG;Zaidat OO;Saver JL;SWIFT Investigators
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