PMID- 31985746 OWN - NLM STAT- MEDLINE DCOM- 20210216 LR - 20210216 IS - 2168-6157 (Electronic) IS - 2168-6149 (Print) IS - 2168-6149 (Linking) VI - 77 IP - 5 DP - 2020 May 1 TI - Blood Pressure Thresholds and Neurologic Outcomes After Endovascular Therapy for Acute Ischemic Stroke: An Analysis of Individual Patient Data From 3 Randomized Clinical Trials. PG - 622-631 LID - 10.1001/jamaneurol.2019.4838 [doi] AB - IMPORTANCE: The optimal blood pressure targets during endovascular therapy (EVT) for acute ischemic stroke (AIS) are unknown. OBJECTIVE: To study whether procedural blood pressure parameters, including specific blood pressure thresholds, are associated with neurologic outcomes after EVT. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included adults with anterior-circulation AIS who were enrolled in randomized clinical trials assessing anesthetic strategy for EVT between February 2014 and February 2017. The trials had comparable blood pressure protocols, and patients were followed up for 90 days. A total of 3630 patients were initially approached, and 3265 patients were excluded. EXPOSURE: Endovascular therapy. MAIN OUTCOMES AND MEASURES: The primary efficacy variable was functional outcome as defined by the modified Rankin Scale (mRS) score at 90 days. Associations of blood pressure parameters and time less than and greater than mean arterial blood pressure (MABP) thresholds with outcome were analyzed. RESULTS: Of the 365 patients included in the analysis, the mean (SD) age was 71.4 (13.0) years, 163 were women (44.6%), and the median National Institutes of Health Stroke Scale score was 17 (interquartile range [IQR], 14-21). For the entire cohort, 182 (49.9%) received general anesthesia and 183 (50.1%) received procedural sedation. A cumulated period of minimum 10 minutes with less than 70 mm Hg MABP (adjusted OR, 1.51; 95% CI, 1.02-2.22) and a continuous episode of minimum 20 minutes with less than 70 mm Hg MABP (adjusted OR, 2.30; 95% CI, 1.11-4.75) were associated with a shift toward higher 90-day mRS scores, corresponding to a number needed to harm of 10 and 4, respectively. A cumulated period of minimum 45 minutes with greater than 90 mm Hg MABP (adjusted OR, 1.49; 95% CI, 1.11-2.02) and a continuous episode of minimum 115 minutes with greater than 90 mm Hg MABP (adjusted OR, 1.89; 95% CI, 1.01-3.54) were associated with a shift toward higher 90-day mRS scores, corresponding to a number needed to harm of 10 and 6, respectively. CONCLUSIONS AND RELEVANCE: Critical MABP thresholds and durations for poor outcome were found to be MABP less than 70 mm Hg for more than 10 minutes and MABP greater than 90 mm Hg for more than 45 minutes, both durations with a number needed to harm of 10 patients. Mean arterial blood pressure may be a modifiable therapeutic target to prevent or reduce poor functional outcome after EVT. FAU - Rasmussen, Mads AU - Rasmussen M AD - Department of Anesthesia, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark. FAU - Schonenberger, Silvia AU - Schonenberger S AD - Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany. FAU - Henden, Pia Lowhagen AU - Henden PL AD - Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. FAU - Valentin, Jan B AU - Valentin JB AD - Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark. FAU - Espelund, Ulrick S AU - Espelund US AD - Department of Anesthesiology and Intensive Care Medicine, Regional Hospital in Horsens, Horsens, Denmark. FAU - Sorensen, Leif H AU - Sorensen LH AD - Department of Neuroradiology, Aarhus University Hospital, Aarhus, Denmark. FAU - Juul, Niels AU - Juul N AD - Department of Anesthesia, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark. FAU - Uhlmann, Lorenz AU - Uhlmann L AD - Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany. FAU - Johnsen, Soren P AU - Johnsen SP AD - Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark. FAU - Rentzos, Alexandros AU - Rentzos A AD - Department of Radiology, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden. FAU - Bosel, Julian AU - Bosel J AD - Department of Neurology, Klinikum Kassel, Kassel, Germany. FAU - Simonsen, Claus Z AU - Simonsen CZ AD - Department of Neurology, Aarhus University Hospital, Aarhus, Denmark. CN - SAGA collaborators LA - eng PT - Journal Article PL - United States TA - JAMA Neurol JT - JAMA neurology JID - 101589536 SB - IM MH - Aged MH - Aged, 80 and over MH - Anesthesia, General/methods MH - Blood Pressure/*physiology MH - Conscious Sedation/methods MH - *Endovascular Procedures MH - Female MH - Humans MH - Ischemic Stroke/*physiopathology/*surgery MH - Male MH - Middle Aged MH - Randomized Controlled Trials as Topic MH - *Recovery of Function MH - Retrospective Studies MH - Risk Factors PMC - PMC6990929 COIS- Conflict of Interest Disclosures: Dr Rasmussen was supported by a grant from the Health Research Foundation of Central Denmark Region and the National Helicopter Emergency Medical Service Foundation, Denmark. Dr Simonsen is supported by a grant from The Novo Nordisk Foundation. Dr Rentzos has received personal fees from Abbott Medical Sweden and I4L Innovation for Life PC. Dr Bosel has received personal fees from Boehringer Ingelheim, Medtronic, and Zoll, and an unrelated research award from Patient-Centered Outcomes Research Institute. No other disclosures were reported. EDAT- 2020/01/28 06:00 MHDA- 2021/02/17 06:00 PMCR- 2021/01/27 CRDT- 2020/01/28 06:00 PHST- 2020/01/28 06:00 [pubmed] PHST- 2021/02/17 06:00 [medline] PHST- 2020/01/28 06:00 [entrez] PHST- 2021/01/27 00:00 [pmc-release] AID - 2758832 [pii] AID - noi190114 [pii] AID - 10.1001/jamaneurol.2019.4838 [doi] PST - ppublish SO - JAMA Neurol. 2020 May 1;77(5):622-631. doi: 10.1001/jamaneurol.2019.4838.