Good outcome associated with blood-brain barrier disruption and lower blood pressure after endovascular therapy.
Good outcome associated with blood-brain barrier disruption and lower blood pressure after endovascular therapy.
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DOI：
10.1016/j.jstrokecerebrovasdis.2022.106870
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发表时间：
2022-11
期刊：
影响因子：
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通讯作者：
P. Upadhyaya;A. Mehta;M. Luby;S. Ansari;J. Lynch;A. Hsia;L. Latour;Yongwoo Kim
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文献类型：
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作者：
P. Upadhyaya;A. Mehta;M. Luby;S. Ansari;J. Lynch;A. Hsia;L. Latour;Yongwoo Kim
目的评价MRI或CT显示血管内血栓切除术（EVT）后血脑屏障（BBB）破坏与平均收缩压（SBP）之间的关系，并获得良好的90天功能结局。观察性研究发现，SBP升高与EVT后的不良结局相关，而最近的随机试验发现目标血压降低无差异。可能有一个亚组的患者受益于有针对性的降低血压post-EVT.MethodsThis是一项单中心研究1）前大血管闭塞中风患者治疗EVT从2015年至2021年，2）达到mTICI 2b或3级。高信号急性再灌注标志物（HARM）、出血性转化（HT）和EVT后3 h和24 h成像时的中线移位由多名评估者独立评估。二元逻辑回归模型用于确定EVT后SBP与结局的相关性。BBB破坏被定义为HT或HARM 3小时后EVT imaging.ResultsOf 103例患者，那些SBP 100-129与SBP 130-160发现没有显着差异，在良好的90天的结果（64%vs.46%，OR2.11，95%CI 0.78-5.76，p=0.143）。然而，在71例BBB破坏患者中，SBP 100-129组的有利结局为64%，SBP 130-160组为39%，两者之间存在显著差异（OR 5.93，95%CI 1.50-23.45，p=0.011）。在症状性ICH、90天死亡率、中线移位（≥5 mm）和半颅骨切除术方面，结论EVT后3 h BBB破坏和较低的SBP与良好的结局相关。这一影像学发现可能指导靶向BP治疗，并建议需要进行随机对照试验。
ObjectivesTo evaluate the association between post-endovascular thrombectomy (EVT) blood-brain barrier (BBB) disruption on MRI or CT and average systolic blood pressure (SBP) with favorable 90-day functional outcome. Observational studies have found elevated SBP associated with worse outcomes post-EVT, while recent randomized trials found no difference in targeted BP reduction. There may be a subgroup of patients who benefit from targeted BP reduction post-EVT.MethodsThis is a single-center study of 1) anterior large vessel occlusion stroke patients treated with EVT from 2015 to 2021, 2) achieved mTICI grade 2b or 3. Hyperintense acute reperfusion marker (HARM), hemorrhagic transformation (HT), and midline shift at 3 h post-EVT and 24 h imaging were assessed independently by multiple raters. Binary logistic regression models were used to determine the association of post-EVT SBP with outcomes. BBB disruption was defined as HT or HARM on 3h post-EVT imaging.ResultsOf 103 patients, those with SBP 100-129 versus SBP 130-160 found no significant difference in favorable 90-day outcome (64% vs. 46%, OR 2.11, 95% CI 0.78-5.76, p=0.143). However, among 71 patients with BBB disruption, a significant difference in favorable outcome of 64% in SBP 100-129 vs. 39% in SBP 130-160 group (OR 5.93, 95% CI 1.50-23.45, p=0.011) was found. There was no difference in symptomatic ICH, 90-day mortality, midline shift (≥5 mm), and hemicraniectomy, between BP or BBB groups.ConclusionsBBB disruption on 3h post-EVT imaging and lower SBP was associated with favorable outcome. This imaging finding may guide targeted BP therapy and suggests need for a randomized control trial.