Table 3.
Post-procedural BP and the recanalization treatment outcomes
| Study | Year | Study subjects | Major BP indices | Major findings |
|---|---|---|---|---|
| Martins et al. [79] | 2016 | 674 IVT or EVT cases | BP every 2 hours for 24 hours after admission | SBP showed J-shape in non-recanalized group but linear association in recanalized group |
| Mistry et al. [80] | 2017 | 228 EVT from three hospitals | BP (max, min, and average) in the first 24 hours after EVT | High peak SBP correlated with worse functional outcome and hemorrhagic complications |
| Goyal et al. [65] | 2017 | 217 LVO with EVT with hourly BP | BP goals post EVT; permissive hypertension (<220 or 185), moderate BP control (<160), intensive BP control (<140) | Higher SBPmax associated with mortality |
| Intensive BP target (<140/90 mm Hg) associated with higher rates of mRS 0–2 | ||||
| Bennett et al. [71] | 2018 | 182 LVO patients with EVT | Post-procedural BP variability indices; SD, CV, and SV | High BPV associated with high mRS |
| Chang et al. [81] | 2018 | 303 LVO patients with EVT | Post-procedural BP variability indices; SD, CV, and VIM | High BPV associated with poor functional recovery and low successful recanalization |
| Maier et al. [67] | 2018 | 168 Anterior circulation occlusions with successful recanalization after EVT | Mean, max, and peak SBP for the first 24 hours after successful EVT | High mean SBP and maximum SBP associated with unfavorable outcome |
| Martins et al. [82] | 2018 | 674 IVT or EVT | Standard deviations of SBP and DBP during the first 24 hours after stroke | A differential effect from SD of SBP on mRS by recanalization status; significant only in non-recanalized patients |
| Schonenberger et al. [40]* | 2018 | 150 EVT cases randomized to GA or CS from the SIESTA trial | BP measurements were divided into 4 phases: pre-EVT, pre-recanalization, post-recanalization, and post-EVT | No association between the difference in SBP, DBP, and MAP from baseline to the different phases of intervention and NIHSS change after 24 hours |
| No association of BP drops with a change in mRS | ||||
| Cernik et al. [66] | 2019 | 690 EVT patients | Levels of SBP and DBP | Low BP levels associated with better functional recovery or recanalization |
| Chang et al. [83] | 2019 | 90 EVT with mTICI ≥2b | BP variability indices | BP variability associated with poor mRS only in patients with poor collaterals at baseline |
| Cho et al. [84] | 2019 | 378 EVTs | Levels and variability indices during the first 24 hours after admission | Higher mean SBP and SV of SBP associated with poor mRS; the effect of SV modified by recanalization status |
| Choi et al. [85] | 2019 | 1,540 AIS patients after IVT or EVT | BP ≤130/80 mm Hg | Lower BP levels associated with mRS 0–2 |
| Kim et al. [73] | 2019 | 211 EVT with mTICI ≥2b | Levels, excursions, variability indices, and time rate of BP variation | BP variability indices associated with higher rates of SICH |
| Mistry et al. [70] | 2019 | 485 Consecutive EVT patients from 12 centers | All SBP values within 24 hours post EVT | Peak SBP <158 mm Hg associated with good functional outcome |
| Overall, SBP showed a U-shape association with outcome | ||||
| Higher BP levels after EVT associated with poor outcome | ||||
| Zhang et al. [86] | 2019 | 72 LVOs with EVT | Post-procedural BP variability indices; SD, CV, and SV | Higher SV of SBP correlated with mRS at 3 months |
| Anadani et al. [87] | 2020 | 1,361 EVT cases from an international multicenter study | SBP reduction in the first 24 hours after EVT | SBP reduction associated with a good outcome only in patients with complete reperfusion (mTICI, 3) |
| Anadani et al. [88] | 2020 | 433 EVT cases from the BEST study [70] | SBP reduction, the absolute difference between admission SBP and mean SBP in the first 24 hours | No association between SBP with poor outcome or death |
| Anadani et al. [76] | 2020 | 1,019 Anterior circulation occlusion patients with EVT from eight comprehensive stroke centers | Post-EVT BP target, <140, <160, and <180 | Lower SBP goal (<140 or <160, compared to <180) associated with good outcome |
| However, mean achieved SBP levels tended to overlap | ||||
| Cheng et al. [68] | 2020 | 124 Anterior circulation occlusion patients with EVT | Two BP measurements immediately after successful recanalization | Higher BP associated with PH2 hemorrhagic transformation |
| Chu et al. [89] | 2019 | 166 EVT patients | Hourly BP after EVT, by 1–6, 7–12, 13–18, and 19–24 hours | Lower mean, max, SD of SBP, and DBP associated with functional independence, in <6 hours |
| Dias et al. [90] | 2020 | 458 EVT cases | Median SBP within the first hour after EVT | Lower median SBP associated with NIHSS reduction by 8 or ≤2 at 24 hours |
| Ding et al. [91] | 2020 | 262 EVT cases | Maximum SBP and DBP for 24 hours after the EVT | Max SBP associated with poor mRS and parenchymal hemorrhage (hyper attenuated lesion on immediate CT, cannot distinguish from contrast staining) |
| Matusevicius et al. [69] | 2020 | 3,631 EVT cases from the SITS-ISTR | Mean 24-hour SBP after EVT | Higher SBP associated with poor functional recovery in successful recanalization patients and with SICH in all recanalization |
| McCarthy et al. [92] | 2020 | 212 EVT patients | Daily peak SBP and DBP | Higher peak 24-hour SBP associated with SICH and poor outcome |
| Higher peak SBP at day 2 and day 3 associated with poor outcome | ||||
| Mistry et al. [72] | 2020 | 443 EVT cases from the BEST study [70] | Systolic BPV (SD, CV, ARV, SV, and rSD) during 24 hours after EVT | Higher BP variability associated with poor outcome and mortality |
| Anadani et al. [74] | 2021 | 5,835 EVT patients from the SITS-ISTR registry | Delta SBP (SBP–baseline SBP) 0–2/2–4/4–12/12–24 hours | SBP elevation after EVT associated with poor functional outcome |
| Gigliotti et al. [93] | 2021 | 117 EVT cases | SBP for 24 hours after EVT | SBP ≥180 associated with poor function at discharge but not at 3 months |
| SBP ≥160 associated with malignant cerebral edema with lower symptomatic hemorrhage | ||||
| Han et al. [94] | 2021 | 187 BAO with EVT | Levels of SBP, MAP, and DBP | Maximum SBP and maximum MAP associated with mortality |
| Huang et al. [95] | 2021 | 502 Anterior circulation LVO patients with EVT | Levels and variability indices of SBP and DBP | High BP variability associated with poor functional recovery and hemorrhagic complications, differentiated by recanalization status, not by baseline collaterals |
| Liu et al. [77] | 2021 | 596 LVO patients with EVT (GA in 37%) | BP for 24 hours after EVT | Higher mean SBP levels, mean SBP >140, and SD of SBP associated with the unfavorable outcome only in poor collaterals subgroup |
| Mazighi et al. [75] | 2021 | 324 LVO patients with EVT (BP-TARGET trial) | Randomized to intensive SBP target (100–129) vs. standard SBP target (130–185) for 24 hours | No difference in the primary outcome (any hemorrhage or hypotensive event) |
| Castro et al. [78] | 2021 | 146 Anterior circulation LVO with successful recanalization | Spectral analysis of 5-minute recordings of beat-to-beat BP | High frequency BP variability associated with cerebral edema and unfavorable functional outcomes |
BP, blood pressure; IVT, intravenous thrombolysis; EVT, endovascular treatment; SBP, systolic blood pressure; LVO, large vessel occlusion; mRS, modified Rankin Scale; SD, standard deviation; CV, coefficient of variation; SV, successive variation; BPV, BP variability; VIM, variation independent of the mean; GA, general anesthesia; CS, conscious sedation; SIESTA, Sedation vs. Intubation for Endovascular Stroke Treatment trial; DBP, diastolic blood pressure; MAP, mean arterial pressure; NIHSS, National Institutes of Health Stroke Scale; mTICI, modified treatment in cerebral ischemia; AIS, acute ischemic stroke; SICH, symptomatic intracranial hemorrhage; BEST, Blood Pressure after Endovascular Therapy for Ischemic Stroke study; CT, computed tomography; PH2, parenchymal hemorrhage type 2; SITS-ISTR, Safe Implementation of Thrombolysis in Stroke International Stroke Thrombolysis Registry; ARV, average real variation; rSD, residual standard deviation; BAO, basilar artery occlusion; BP-TARGET, Blood Pressure target in Acute Stroke to Reduce Hemorrhage after Endovascular Therapy trial.
*
This article covers all peri-EVT periods.