Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure.

IF 5.8 3区 医学 Q1 CLINICAL NEUROLOGY European Stroke Journal Pub Date : 2024-08-30 DOI:10.1177/23969873241274512
Anna Andriana Kyselyova, Caspar Brekenfeld, Lucas Meyer, Helena Guerreiro, Gabriel Broocks, Susan Klapproth, Tobias Faizy, Christian Heitkamp, Malte Issleib, Jens Fiehler, Fabian Flottmann
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Abstract

Introduction: Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy.

Patients and methods: Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b.

Results: Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, p = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; p < 0.001). No diastolic pressure changes were significant.

Discussion and conclusions: Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.

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在大血管闭塞的机械血栓切除术中,血流恢复与全身血压的即时降低有关。
导言:大血管闭塞患者的血压管理会影响梗死面积和临床预后。我们研究了在机械血栓切除术中恢复血流如何影响全身血压:筛选了 2016 年 6 月至 2018 年 1 月间接受机械血栓切除术的前循环大血管闭塞患者。我们纳入了在局部麻醉或有意识镇静下接受治疗的患者,并分析了标准化麻醉方案,以评估整个手术过程中的收缩压和舒张压水平。主要结果是血压的变化,比较最后一次再灌注尝试前 5 分钟和尝试后 5 分钟的血压变化。脑梗塞溶栓评分⩾ 2b 定义为再灌注成功:134例患者中,117例(87%)血管再灌注成功,血流恢复后5分钟收缩压明显下降(10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg,p = 0.009)。在多变量逻辑回归中,血管再灌注成功是导致血压下降的重要预测因素:OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299)。在 66 名未服用影响循环药物的患者中,也观察到收缩压显著降低(从 155 ± 17 mm Hg 降至 148 ± 17 mm Hg;p 讨论和结论:在局部麻醉或有意识镇静状态下接受机械再通术的患者,血流恢复与收缩压值的立即降低有关。这表明血管内卒中治疗与心血管血流动力学之间存在复杂的相互作用。
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来源期刊
CiteScore
7.50
自引率
6.60%
发文量
102
期刊介绍: Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.
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