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Abstract：
Background/Objectives: Periprocedural blood pressure changes in stroke patients with a large vessel occlusion are a known modifiable risk factor of unfavorable treatment outcomes. We aimed to evaluate the association between pre-revascularization hypotension and the final infarct volume. Methods: In our retrospective analysis, we included 214 consecutive stroke patients with an anterior circulation large vessel occlusion that underwent mechanical thrombectomy under general anesthesia. Noninvasively obtained blood pressure values prior to symptomatic vessel recanalization were analyzed as a predictor of post-treatment infarct size. Linear logistic regression models adjusted for predefined factors were used to investigate the association between blood pressure parameters and the final infarct volume. Results: In our cohort, higher baseline systolic blood pressure (aβ = 8.32, 95% CI 0.93-15.7, p = 0.027), its maximal absolute drop (aβ = 6.98, 95% CI 0.42-13.55, p = 0.037), and >40% mean arterial pressure decrease (aβ = 41.77, CI 95% 1.93-81.61, p = 0.040) were independently associated with higher infarct volumes. Similarly, continuous hypotension measured as intraprocedural cumulative time spent below either 100 mmHg (aβ = 3.50 per 5 min, 95% CI 1.49-5.50, p = 0.001) or 90 mmHg mean arterial pressure (aβ = 2.91 per 5 min, 95% CI 0.74-5.10, p = 0.010) was independently associated with a larger ischemia size. In the subgroup analysis of 151 patients with an M1 middle cerebral artery occlusion, two additional factors were independently associated with a larger ischemia size: systolic blood pressure maximal relative drop and >40% drop from pretreatment value (aβ = 1.36 per 1% lower than baseline, 95% CI 0.04-2.67, p = 0.043, and aβ = 43.01, 95% CI 2.89-83.1, p = 0.036, respectively). No associations between hemodynamic parameters and post-treatment infarct size were observed in the cohort of intracranial internal carotid artery occlusion. Conclusions: In patients with ischemic stroke due to a proximal middle cerebral artery occlusion, higher pre-thrombectomy treatment systolic blood pressure is associated with a larger final infarct size. In patients treated under general anesthesia, hypotension prior to the M1 portion of middle cerebral artery recanalization is independently correlated with the post-treatment infarct volume. In this group, every 5 min spent below the mean arterial pressure threshold of 100 mmHg is associated with a 4 mL increase in ischemia volume on a post-treatment NCCT. No associations between blood pressure and final infarct volume were present in the subgroup of patients with an intracranial internal carotid artery occlusion.
摘要：
背景/目标：大血管闭塞的卒中患者的围手术期血压变化是已知的不利治疗结果的可改变的危险因素。我们旨在评估血运重建前低血压与最终梗死体积之间的关系。方法：在我们的回顾性分析中，我们纳入了214例前循环大血管闭塞的连续卒中患者,这些患者在全身麻醉下接受了机械血栓切除术.分析在有症状的血管再通之前无创获得的血压值作为治疗后梗死面积的预测指标。使用根据预定义因素调整的线性逻辑回归模型来研究血压参数与最终梗死体积之间的关联。结果：在我们的队列中，较高的基线收缩压（aβ=8.32，95％CI0.93-15.7，p=0.027），其最大绝对下降(aβ=6.98，95%CI0.42-13.55，p=0.037)，平均动脉压下降>40%(aβ=41.77,CI95%1.93-81.61,p=0.040)与较高的梗死体积独立相关。同样，连续低血压以术中累积时间低于100mmHg（aβ=3.50/5分钟，95%CI1.49-5.50，p=0.001）或90mmHg平均动脉压（aβ=2.91每5分钟，95%CI0.74-5.10，p=0.010）与较大的缺血面积独立相关。在151例M1大脑中动脉闭塞患者的亚组分析中，另外两个因素与较大的缺血大小独立相关:收缩压最大相对下降和比治疗前值下降>40%(aβ=1.36每1%低于基线,95%CI0.04-2.67，p=0.043，aβ=43.01，95%CI2.89-83.1，p=0.036）。在颅内颈内动脉闭塞队列中，未观察到血流动力学参数与治疗后梗死面积之间的关联。结论：在大脑中动脉近端闭塞引起的缺血性卒中患者中，较高的血栓切除术前收缩压与较大的最终梗死面积相关.在全身麻醉下治疗的患者中，大脑中动脉再通M1部分之前的低血压与治疗后的梗死体积独立相关。在这个群体中,在治疗后的NCCT中,每5分钟低于平均动脉压阈值100mmHg与缺血体积增加4mL相关.在颅内颈内动脉闭塞患者亚组中，血压与最终梗死体积之间没有相关性。
