Blood Pressure Variability in Thrombectomy for Acute Ischemic Stroke: Post-Hoc Analysis of the BP-TARGET trial

Abstract

Background: Factors associated with blood pressure variability (BPV) in acute ischemic stroke (AIS) patients undergoing thrombectomy have not been well established. Therefore, we performed a post-hoc analysis of the BP-TARGET trial, evaluating the relationship between BPV, post-procedural intraparenchymal hemorrhage (IPH), and functional independence at 90 days.

Methods: For 24 h after thrombectomy, blood pressure values were recorded and BPV was quantified by calculating the following indices: 24-h average real variability (AVR₂₄), time rate index (TRI), successive variability (SV), standard deviation (SD), and range for systolic, diastolic, and mean arterial blood pressures. We assessed the effect of initial National Institutes of Health Stroke Scale (NIHSS) score, age, modified Thrombolysis in Cerebral Infarction (mTICI) score, and initial systolic blood pressure post-procedure on BPV, as well as the effect of BPV on IPH at 24 h and functional independence defined as modified Rankin Scale (mRS) of 0-2 at 90 days.

Results: A total of 193 AIS patients (mean age 72.7 ± 13.6 years), with an average post-procedure systolic blood pressure of 152.8 ± 25.6 mm Hg, were analyzed. An mTICI score of 2b (incomplete/subtotal recanalization), compared with mTICI score of 3 (full recanalization), predicted increased BPV (ARV: P = 0.014, TRI: P = 0.028, and SV: P = 0.030). There was no association between BPV and functional independence at 90 days (ARV: P = 0.185, TRI: P = 0.657, and SV: P = 0.550), or BPV and post-procedural IPH.

Conclusion: In this post-hoc analysis of the BP-TARGET trial, better recanalization was associated with decreased BPV in AIS patients post-thrombectomy. Nevertheless, we found no association between BPV indices and functional independence at 90 days or post-procedural IPH.