Effect of Steady and Dynamic Blood Pressure Parameters During Thrombectomy According to the Collateral Status.

Details

Serval ID
serval:BIB_9609A959110F
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Effect of Steady and Dynamic Blood Pressure Parameters During Thrombectomy According to the Collateral Status.
Journal
Stroke
Author(s)
Maïer B., Dargazanli C., Bourcier R., Kyheng M., Labreuche J., Mosimann P.J., Puccinelli F., Taylor G., Le Guen M., Riem R., Desilles J.P., Boisseau W., Fahed R., Redjem H., Smajda S., Ciccio G., Escalard S., Blanc R., Piotin M., Lapergue B., Mazighi M.
Working group(s)
ASTER Trial
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
04/2020
Peer-reviewed
Oui
Volume
51
Number
4
Pages
1199-1206
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Randomized Controlled Trial
Publication Status: ppublish
Abstract
Background and Purpose- Guidelines regarding blood pressure (BP) management during endovascular therapy (EVT) for anterior circulation strokes are questionable since the optimal BP target is a matter of debate. To evaluate the importance of hemodynamic control during EVT, we investigated the impact of dynamic and steady BP parameters during EVT on functional outcome (part 1) and according to the collateral status (CS; part 2). Methods- We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Recanalization). BP was measured noninvasively during EVT and CS assessed on the angiographic run before EVT. We studied dynamic BP parameter using BP variability (coefficient of variation) and steady BP parameter (hypotension time defined as systolic BP <140 mm Hg and mean arterial pressure <90 mm Hg). The primary outcome was favorable outcome defined as a 3-month modified Rankin Scale score between 0 and 2. Results- Among the 381 patients of the ASTER study, 172 patients were included in part 1 and 159 in part 2. Systolic BP, diastolic BP, and mean arterial pressure variability were negatively associated with favorable outcome regardless of CS: per 10-unit increase, adjusted odds ratios were 0.45 (95% CI, 0.20-0.98), 0.37 (95% CI, 0.19-0.72), and 0.35 (95% CI, 0.16-0.76), respectively. According to CS, the hypotension time with periprocedural mean arterial pressure <90 mm Hg was negatively associated with favorable outcome in patients with poor CS (adjusted odds ratio, 0.88 [95% CI, 0.72-1.09]) but not in patients with good CS (adjusted odds ratio, 1.24 [95% CI, 0.91-1.67]; P <sub>het</sub> =0.047). Conclusions- The CS did not modify the association between dynamic parameters and functional outcomes, but some findings suggest that the CS modifies the association between steady parameter and functional outcomes. Hypotension time according to the CS was not statistically predictive of poor outcomes but displayed a trend toward worse outcomes for patients with poor CS only.
Keywords
Aged, Aged, 80 and over, Blood Pressure/physiology, Blood Pressure Determination/methods, Collateral Circulation/physiology, Female, Humans, Male, Middle Aged, Monitoring, Intraoperative/methods, Single-Blind Method, Stroke/diagnosis, Stroke/physiopathology, Stroke/surgery, Thrombectomy/methods, Treatment Outcome, blood pressure, collateral circulation, humans, stents, thrombectomy
Pubmed
Web of science
Open Access
Yes
Create date
19/09/2020 14:58
Last modification date
12/03/2024 7:09
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