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Temporal profiles of systolic blood pressure variability and neurologic outcomes after endovascular thrombectomy.
Prasad, Ayush; Kobsa, Jessica; Kodali, Sreeja; Bartolome, David; Begunova, Liza; Quispe-Orozco, Darko; Farooqui, Mudassir; Zevallos, Cynthia; Ortega-Gutiérrez, Santiago; Anadani, Mohammad; Almallouhi, Eyad; Spiotta, Alejandro M; Giles, James A; Keyrouz, Salah G; Kim, Joon-Tae; Maier, Ilko L; Liman, Jan; Psychogios, Marios-Nikos; Riou-Comte, Nolwenn; Richard, Sébastien; Gory, Benjamin; Quintero Wolfe, Stacey; Brown, Patrick A; Fargen, Kyle M; Mistry, Eva A; Fakhri, Hiba; Mistry, Akshitkumar; Wong, Ka-Ho; Nascimento, Fábio A; Kan, Peter; de Havenon, Adam; Sheth, Kevin N; Petersen, Nils H.
Afiliación
  • Prasad A; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
  • Kobsa J; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
  • Kodali S; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
  • Bartolome D; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
  • Begunova L; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
  • Quispe-Orozco D; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
  • Farooqui M; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
  • Zevallos C; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
  • Ortega-Gutiérrez S; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
  • Anadani M; Departments of Neurology, Medical University of South Carolina, Charleston, SC, USA.
  • Almallouhi E; Departments of Neurology, Medical University of South Carolina, Charleston, SC, USA.
  • Spiotta AM; Departments of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
  • Giles JA; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
  • Keyrouz SG; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
  • Kim JT; Department of Neurology, Chonnam National University Medical School, Gwangju, South Korea.
  • Maier IL; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
  • Liman J; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany.
  • Psychogios MN; Department of Diagnostic and Interventional Neuroradiology, University Clinic Basel, Basel, Switzerland.
  • Riou-Comte N; Department of Neurology, University Hospital of Nancy, Nancy, France.
  • Richard S; Department of Neurology, University Hospital of Nancy, Nancy, France.
  • Gory B; Centre d'Investigation Clinique Plurithématique, INSERM U1116, University Hospital of Nancy, Vandoeuvre-lès-Nancy, France.
  • Quintero Wolfe S; Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France.
  • Brown PA; IADI, INSERM U1254, University of Lorraine, Nancy, France.
  • Fargen KM; Departments of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
  • Mistry EA; Departments of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
  • Fakhri H; Departments of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.
  • Mistry A; Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA.
  • Wong KH; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN.
  • Nascimento FA; Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
  • Kan P; Department of Neurology, University of Utah School of Medicine, Salt Lake City, UT, USA.
  • de Havenon A; Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
  • Sheth KN; Department of Neurology, Baylor College of Medicine, Houston, TX, USA.
  • Petersen NH; Department of Neurology, Yale University School of Medicine, New Haven, CT, USA.
Eur Stroke J ; 7(4): 365-375, 2022 Dec.
Article en En | MEDLINE | ID: mdl-36478756
Introduction: Observational studies have found an increased risk of hemorrhagic transformation and worse functional outcomes in patients with higher systolic blood pressure variability (BPV). However, the time-varying behavior of BPV after endovascular thrombectomy (EVT) and its effects on functional outcome have not been well characterized. Patients and methods: We analyzed data from an international cohort of patients with large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 h after thrombectomy. Parameters of BPV were calculated in 12-h epochs using five established methodologies. Systolic BPV trajectories were generated using group-based trajectory modeling, which separates heterogeneous longitudinal data into groups with similar patterns. Results: Of the 2041 patients (age 69 ± 14, 51.4% male, NIHSS 15 ± 7, mean number of BP measurements 50 ± 28) included in our analysis, 1293 (63.4%) had a poor 90-day outcome (mRS ⩾ 3) or a poor discharge outcome (mRS ⩾ 3). We identified three distinct SBP trajectories: low (25%), moderate (64%), and high (11%). Compared to patients with low BPV, those in the highest trajectory group had a significantly greater risk of a poor functional outcome after adjusting for relevant confounders (OR 2.2; 95% CI 1.2-3.9; p = 0.008). In addition, patients with poor outcomes had significantly higher systolic BPV during the epochs that define the first 24 h after EVT (p < 0.001). Discussion and conclusions: Acute ischemic stroke patients demonstrate three unique systolic BPV trajectories that differ in their association with functional outcome. Further research is needed to rapidly identify individuals with high-risk BPV trajectories and to develop treatment strategies for targeting high BPV.
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Texto completo: 1 Bases de datos: MEDLINE Tipo de estudio: Observational_studies Idioma: En Revista: Eur Stroke J Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos

Texto completo: 1 Bases de datos: MEDLINE Tipo de estudio: Observational_studies Idioma: En Revista: Eur Stroke J Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos