Elevated BP Variability During Transport for Endovascular Thrombectomy Is Associated With Worse Functional Outcome

April 28, 2021

By Erika Powers

VIRTUAL -- April 27, 2021 -- Elevated pre-procedural blood pressure variability during interhospital transport for endovascular thrombectomy is associated with lower odds of good functional outcome at 90 days, according to a study presented at the Virtual 2021 Annual Meeting of the American Academy of Neurology (AAN).

“Studies have shown that elevated blood pressure variability following endovascular thrombectomy for large vessel occlusion ischaemic stroke is associated with lower odds of good functional outcome,” said Adam de Havenon, MD, University of Utah, Salt Lake City, Utah. “However, pre-procedural blood pressure variability has not been evaluated in this context.”

To further examine, the researchers enrolled 41 sequential patients (mean age, 68.9 years; 58.8% male) who experienced an ischaemic stroke with occlusion of the internal carotid or middle cerebral artery. All patients were treated with endovascular thrombectomy at the University of Utah after transfer from a regional hospital by helicopter, and all patients had at least 3 BP measurements during transport.

The median National Institutes of Health Stroke Scale/Score (NIHSS) was 17 (range, 10-23) and the mean duration of interhospital transit was 178.5 minutes.

Of the patients, 12 (29.3%) had a good functional outcome, defined as a 90-day modified Rankin Scale of 0 to 2.

Blood pressure variability -- defined as the standard deviation (SD) and coefficient of variation (CV = SD/mean) of systolic blood pressure during helicopter transport -- was significantly lower among the patients with good functional outcome versus patients who had a poor outcome (SD: 7.9 ± 3.7 vs 13.2 ± 5.9, P = .006; CV: 5.4 ± 2.6 vs 9.8 ± 5.6, P = .014).

In a multivariate logistic regression model, adjusted for age, sex, baseline NIHSS, post procedural Thrombolysis in Cerebral Infarction score, and number of blood pressure measurements, lower blood pressure variability conitnued to be associated with good outcome (SD: odds ratio [OR] = 0.74, 95% confidence interval [CI], 0.57-0.96, P = .025; CV: OR = 0.65, 95% CI, 0.45-0.95, P = .026).

“Additional research is needed to confirm these preliminary findings,” said Dr. de Havenon.

[Presentation title: Elevated Blood Pressure Variability During Transport for Endovascular Thrombectomy Is Associated With Worse Functional Outcome]