Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment

Nitin Goyal, Georgios Tsivgoulis, Sulaiman Iftikhar, Yasser Khorchid, Muhammad Fawad Ishfaq, Vinodh T. Doss, Ramin Zand, Jason Chang, Khalid Alsherbini, Asim Choudhri, Daniel Hoit, Andrei Alexandrov, Adam Arthur, Lucas Elijovich

Research output: Contribution to journalArticle

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Abstract

Background and purpose High admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). We sought to evaluate the association of admission BP with early outcomes in patients with ELVO treated with EVT. Methods Consecutive patients with AIS presenting with ELVO in a tertiary stroke center during a 4-year period were prospectively evaluated. Admission systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated cuff recordings. A blinded neuroradiologist calculated the final infarct volume (FIV) using standardized ABC/2 methodology. A favorable functional outcome (FFO) at 3€ months was defined as modified Rankin Scale score of 0-2. Results Our study population consisted of 116 patients with AIS (mean age 63±13€ years, median NIH Stroke Scale score 17 points (IQR 14-21), median FIV 30€ cm 3 (IQR 8-94)). Higher admission SBP correlated with higher FIV (r +0.225; p=0.020). Patients with FFO had lower admission SBP (151±24€ mm€ Hg vs 165±28€ mm€ Hg; p=0.010), while admission SBP levels were higher in patients who died during hospitalization (169±34€ mm€ Hg vs 156±24€ mm€ Hg; p=0.043). A 10€ mm€ Hg increment in admission SBP was independently (p=0.010) associated with an increase of 12€ cm 3 in FIV (95% CI 3 to 21) in multiple linear regression models adjusting for potential confounders. A 10€ mm€ Hg increment in admission SBP was independently (p=0.012) associated with a lower likelihood of FFO at 3€ months (OR 0.64; 95% CI 0.45 to 0.91) in multiple logistic regression models adjusting for potential confounders. Conclusions Higher admission SBP is an independent predictor of increased FIV and lower likelihood of 3-month FFO in patients with ELVO treated with EVT.

Original languageEnglish (US)
Pages (from-to)451-454
Number of pages4
JournalJournal of NeuroInterventional Surgery
Volume9
Issue number5
DOIs
StatePublished - May 1 2017

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Stroke
Blood Pressure
Therapeutics
Linear Models
Logistic Models
Hospitalization
Hypertension

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

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Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment. / Goyal, Nitin; Tsivgoulis, Georgios; Iftikhar, Sulaiman; Khorchid, Yasser; Fawad Ishfaq, Muhammad; Doss, Vinodh T.; Zand, Ramin; Chang, Jason; Alsherbini, Khalid; Choudhri, Asim; Hoit, Daniel; Alexandrov, Andrei; Arthur, Adam; Elijovich, Lucas.

In: Journal of NeuroInterventional Surgery, Vol. 9, No. 5, 01.05.2017, p. 451-454.

Research output: Contribution to journalArticle

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abstract = "Background and purpose High admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). We sought to evaluate the association of admission BP with early outcomes in patients with ELVO treated with EVT. Methods Consecutive patients with AIS presenting with ELVO in a tertiary stroke center during a 4-year period were prospectively evaluated. Admission systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated cuff recordings. A blinded neuroradiologist calculated the final infarct volume (FIV) using standardized ABC/2 methodology. A favorable functional outcome (FFO) at 3€ months was defined as modified Rankin Scale score of 0-2. Results Our study population consisted of 116 patients with AIS (mean age 63±13€ years, median NIH Stroke Scale score 17 points (IQR 14-21), median FIV 30€ cm 3 (IQR 8-94)). Higher admission SBP correlated with higher FIV (r +0.225; p=0.020). Patients with FFO had lower admission SBP (151±24€ mm€ Hg vs 165±28€ mm€ Hg; p=0.010), while admission SBP levels were higher in patients who died during hospitalization (169±34€ mm€ Hg vs 156±24€ mm€ Hg; p=0.043). A 10€ mm€ Hg increment in admission SBP was independently (p=0.010) associated with an increase of 12€ cm 3 in FIV (95{\%} CI 3 to 21) in multiple linear regression models adjusting for potential confounders. A 10€ mm€ Hg increment in admission SBP was independently (p=0.012) associated with a lower likelihood of FFO at 3€ months (OR 0.64; 95{\%} CI 0.45 to 0.91) in multiple logistic regression models adjusting for potential confounders. Conclusions Higher admission SBP is an independent predictor of increased FIV and lower likelihood of 3-month FFO in patients with ELVO treated with EVT.",
author = "Nitin Goyal and Georgios Tsivgoulis and Sulaiman Iftikhar and Yasser Khorchid and {Fawad Ishfaq}, Muhammad and Doss, {Vinodh T.} and Ramin Zand and Jason Chang and Khalid Alsherbini and Asim Choudhri and Daniel Hoit and Andrei Alexandrov and Adam Arthur and Lucas Elijovich",
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T1 - Admission systolic blood pressure and outcomes in large vessel occlusion strokes treated with endovascular treatment

AU - Goyal, Nitin

AU - Tsivgoulis, Georgios

AU - Iftikhar, Sulaiman

AU - Khorchid, Yasser

AU - Fawad Ishfaq, Muhammad

AU - Doss, Vinodh T.

AU - Zand, Ramin

AU - Chang, Jason

AU - Alsherbini, Khalid

AU - Choudhri, Asim

AU - Hoit, Daniel

AU - Alexandrov, Andrei

AU - Arthur, Adam

AU - Elijovich, Lucas

PY - 2017/5/1

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N2 - Background and purpose High admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). We sought to evaluate the association of admission BP with early outcomes in patients with ELVO treated with EVT. Methods Consecutive patients with AIS presenting with ELVO in a tertiary stroke center during a 4-year period were prospectively evaluated. Admission systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated cuff recordings. A blinded neuroradiologist calculated the final infarct volume (FIV) using standardized ABC/2 methodology. A favorable functional outcome (FFO) at 3€ months was defined as modified Rankin Scale score of 0-2. Results Our study population consisted of 116 patients with AIS (mean age 63±13€ years, median NIH Stroke Scale score 17 points (IQR 14-21), median FIV 30€ cm 3 (IQR 8-94)). Higher admission SBP correlated with higher FIV (r +0.225; p=0.020). Patients with FFO had lower admission SBP (151±24€ mm€ Hg vs 165±28€ mm€ Hg; p=0.010), while admission SBP levels were higher in patients who died during hospitalization (169±34€ mm€ Hg vs 156±24€ mm€ Hg; p=0.043). A 10€ mm€ Hg increment in admission SBP was independently (p=0.010) associated with an increase of 12€ cm 3 in FIV (95% CI 3 to 21) in multiple linear regression models adjusting for potential confounders. A 10€ mm€ Hg increment in admission SBP was independently (p=0.012) associated with a lower likelihood of FFO at 3€ months (OR 0.64; 95% CI 0.45 to 0.91) in multiple logistic regression models adjusting for potential confounders. Conclusions Higher admission SBP is an independent predictor of increased FIV and lower likelihood of 3-month FFO in patients with ELVO treated with EVT.

AB - Background and purpose High admission blood pressure (BP) levels have been associated with lower recanalization rates after endovascular treatment (EVT) for patients with acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). We sought to evaluate the association of admission BP with early outcomes in patients with ELVO treated with EVT. Methods Consecutive patients with AIS presenting with ELVO in a tertiary stroke center during a 4-year period were prospectively evaluated. Admission systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured using automated cuff recordings. A blinded neuroradiologist calculated the final infarct volume (FIV) using standardized ABC/2 methodology. A favorable functional outcome (FFO) at 3€ months was defined as modified Rankin Scale score of 0-2. Results Our study population consisted of 116 patients with AIS (mean age 63±13€ years, median NIH Stroke Scale score 17 points (IQR 14-21), median FIV 30€ cm 3 (IQR 8-94)). Higher admission SBP correlated with higher FIV (r +0.225; p=0.020). Patients with FFO had lower admission SBP (151±24€ mm€ Hg vs 165±28€ mm€ Hg; p=0.010), while admission SBP levels were higher in patients who died during hospitalization (169±34€ mm€ Hg vs 156±24€ mm€ Hg; p=0.043). A 10€ mm€ Hg increment in admission SBP was independently (p=0.010) associated with an increase of 12€ cm 3 in FIV (95% CI 3 to 21) in multiple linear regression models adjusting for potential confounders. A 10€ mm€ Hg increment in admission SBP was independently (p=0.012) associated with a lower likelihood of FFO at 3€ months (OR 0.64; 95% CI 0.45 to 0.91) in multiple logistic regression models adjusting for potential confounders. Conclusions Higher admission SBP is an independent predictor of increased FIV and lower likelihood of 3-month FFO in patients with ELVO treated with EVT.

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