Background/Aims
The optimal blood pressure (BP) control strategy after successful endovascular treatment (EVT) is a matter of debate. We hypothesized that low BP after EVT was associated with infarct growth (IG), leading to worse functional outcome. The aims of the present study were to elucidate the relationship between BP and IG on diffusion-weighted imaging (DWI) in patients with acute stroke treated with EVT.
Methods
Among consecutive acute stroke patients received EVT from September 2014 through December 2019, pre-morbidly independent (mRS score 0-2) patients were enrolled. DWI was performed on admission and 36 (±12) hours after onset. IG was calculated as the difference between infarct volume on follow-up DWI and on initial DWI. Mean systolic BP (SBP) was calculated from SBP obtained within 48 hours from EVT. Factors associated with IG were assessed using multiple linear regression analysis.
Results
A total of 233 patients (151 male [65%], median age 75 [IQR 67-81] years, median NIHSS score 15 [8-21]) were enrolled in this study. Mean SBP after EVT showed negligible correlation with IG (Spearman’s ρ = 0.087, p = 0.191). However, multiple linear regression revealed that mean SBP was independently and negatively associated with IG (standardized coefficient -0.193, p = 0.004, i.e., low mean SBP was associated with large IG), even adjusting factors including age, initial NIHSS score, successful reperfusion, and symptomatic intracerebral hemorrhage.
Conclusion
Lower mean SBP after EVT was associated with larger IG. Low mean SBP may lead to worse clinical outcomes via IG in acute stroke patients received EVT.