Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study
Objective Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SB...
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| Veröffentlicht in: | Annals of neurology 2020-06, Vol.87 (6), p.830-839 |
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| creator | Anadani, Mohammad Arthur, Adam S. Tsivgoulis, Georgios Simpson, Kit N. Alawieh, Ali Orabi, Yser Goyal, Nitin Alexandrov, Andrei V. Maier, Ilko L. Psychogios, Marios‐Nikos Liman, Jan Brinton, Daniel Swisher, Christa B. Shah, Shreyash Inamullah, Ovais Keyrouz, Salah Kansagra, Akash P. Allen, Michelle Giles, James A. Wolfe, Stacey Q. Fargen, Kyle M. Gory, Benjamin De Marini, Pierre Kan, Peter Nascimento, Fábio A. Almallouhi, Eyad Petersen, Nils Kodali, Sreeja Rahman, Shareena Richard, Sébastien Spiotta, Alejandro M. |
| description | Objective
Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SBP goals after EVT with SR.
Methods
This international multicenter study included 8 comprehensive stroke centers and patients with anterior circulation large vessel occlusion who were treated with EVT and achieved SR. SR was defined as modified thrombolysis in cerebral ischemia 2b to 3. Patients were divided into 3 groups based on SBP goal in the first 24 hours after EVT. Inverse probability of treatment weighting (IPTW) propensity analysis was used to assess the effect of different SBP goals on clinical outcomes.
Results
A total of 1,019 patients were included. On IPTW analysis, the SBP goal of |
| doi_str_mv | 10.1002/ana.25716 |
| format | Article |
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Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SBP goals after EVT with SR.
Methods
This international multicenter study included 8 comprehensive stroke centers and patients with anterior circulation large vessel occlusion who were treated with EVT and achieved SR. SR was defined as modified thrombolysis in cerebral ischemia 2b to 3. Patients were divided into 3 groups based on SBP goal in the first 24 hours after EVT. Inverse probability of treatment weighting (IPTW) propensity analysis was used to assess the effect of different SBP goals on clinical outcomes.
Results
A total of 1,019 patients were included. On IPTW analysis, the SBP goal of <140mmHg was associated with a higher likelihood of good functional outcome and lower odds of hemicraniectomy compared to SBP goal of <180mmHg. Similarly, SBP goal of <160mmHg was associated with lower odds of mortality compared to SBP goal of <180mmHg. In subgroup analysis including only patients with pre‐EVT SBP of ≥140mmHg, an SBP of <140mmHg was associated with a higher likelihood of good functional outcome, lower odds of symptomatic intracranial hemorrhage, and lower odds of requirement for hemicraniectomy compared to SBP goal of <180mmHg.
Interpretation
SBP goals of <140 and < 160mmHg following SR with EVT appear to be associated with better clinical outcomes than SBP of <180mmHg. ANN NEUROL 2020;87:830–839]]></description><identifier>ISSN: 0364-5134</identifier><identifier>EISSN: 1531-8249</identifier><identifier>DOI: 10.1002/ana.25716</identifier><identifier>PMID: 32187711</identifier><language>eng</language><publisher>Hoboken, USA: John Wiley & Sons, Inc</publisher><subject>Bioengineering ; Blood pressure ; Blood vessels ; Cardiovascular system ; Cerebral blood flow ; Clinical outcomes ; Computer Science ; Hemorrhage ; Human health and pathology ; Ischemia ; Life Sciences ; Medical Imaging ; Nuclear medicine ; Occlusion ; Patients ; Subgroups ; Thrombolysis</subject><ispartof>Annals of neurology, 2020-06, Vol.87 (6), p.830-839</ispartof><rights>2020 American Neurological Association</rights><rights>2020 American Neurological Association.</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3876-5a90aa4d96e58ca8d34e32c93081e2eebd8cfae4f7ad9598f9dee99be0ec71ed3</citedby><cites>FETCH-LOGICAL-c3876-5a90aa4d96e58ca8d34e32c93081e2eebd8cfae4f7ad9598f9dee99be0ec71ed3</cites><orcidid>0000-0002-7813-2949 ; 0000-0002-0640-3797 ; 0000-0001-8441-6326 ; 0000-0001-5059-4095 ; 0000-0001-8424-4464 ; 0000-0002-0945-5656</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fana.25716$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fana.25716$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32187711$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.univ-lorraine.fr/hal-03268669$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Anadani, Mohammad</creatorcontrib><creatorcontrib>Arthur, Adam S.</creatorcontrib><creatorcontrib>Tsivgoulis, Georgios</creatorcontrib><creatorcontrib>Simpson, Kit N.</creatorcontrib><creatorcontrib>Alawieh, Ali</creatorcontrib><creatorcontrib>Orabi, Yser</creatorcontrib><creatorcontrib>Goyal, Nitin</creatorcontrib><creatorcontrib>Alexandrov, Andrei V.</creatorcontrib><creatorcontrib>Maier, Ilko L.</creatorcontrib><creatorcontrib>Psychogios, Marios‐Nikos</creatorcontrib><creatorcontrib>Liman, Jan</creatorcontrib><creatorcontrib>Brinton, Daniel</creatorcontrib><creatorcontrib>Swisher, Christa B.</creatorcontrib><creatorcontrib>Shah, Shreyash</creatorcontrib><creatorcontrib>Inamullah, Ovais</creatorcontrib><creatorcontrib>Keyrouz, Salah</creatorcontrib><creatorcontrib>Kansagra, Akash P.</creatorcontrib><creatorcontrib>Allen, Michelle</creatorcontrib><creatorcontrib>Giles, James A.</creatorcontrib><creatorcontrib>Wolfe, Stacey Q.</creatorcontrib><creatorcontrib>Fargen, Kyle M.</creatorcontrib><creatorcontrib>Gory, Benjamin</creatorcontrib><creatorcontrib>De Marini, Pierre</creatorcontrib><creatorcontrib>Kan, Peter</creatorcontrib><creatorcontrib>Nascimento, Fábio A.</creatorcontrib><creatorcontrib>Almallouhi, Eyad</creatorcontrib><creatorcontrib>Petersen, Nils</creatorcontrib><creatorcontrib>Kodali, Sreeja</creatorcontrib><creatorcontrib>Rahman, Shareena</creatorcontrib><creatorcontrib>Richard, Sébastien</creatorcontrib><creatorcontrib>Spiotta, Alejandro M.</creatorcontrib><title>Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study</title><title>Annals of neurology</title><addtitle>Ann Neurol</addtitle><description><![CDATA[Objective
Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SBP goals after EVT with SR.
Methods
This international multicenter study included 8 comprehensive stroke centers and patients with anterior circulation large vessel occlusion who were treated with EVT and achieved SR. SR was defined as modified thrombolysis in cerebral ischemia 2b to 3. Patients were divided into 3 groups based on SBP goal in the first 24 hours after EVT. Inverse probability of treatment weighting (IPTW) propensity analysis was used to assess the effect of different SBP goals on clinical outcomes.
Results
A total of 1,019 patients were included. On IPTW analysis, the SBP goal of <140mmHg was associated with a higher likelihood of good functional outcome and lower odds of hemicraniectomy compared to SBP goal of <180mmHg. Similarly, SBP goal of <160mmHg was associated with lower odds of mortality compared to SBP goal of <180mmHg. In subgroup analysis including only patients with pre‐EVT SBP of ≥140mmHg, an SBP of <140mmHg was associated with a higher likelihood of good functional outcome, lower odds of symptomatic intracranial hemorrhage, and lower odds of requirement for hemicraniectomy compared to SBP goal of <180mmHg.
Interpretation
SBP goals of <140 and < 160mmHg following SR with EVT appear to be associated with better clinical outcomes than SBP of <180mmHg. ANN NEUROL 2020;87:830–839]]></description><subject>Bioengineering</subject><subject>Blood pressure</subject><subject>Blood vessels</subject><subject>Cardiovascular system</subject><subject>Cerebral blood flow</subject><subject>Clinical outcomes</subject><subject>Computer Science</subject><subject>Hemorrhage</subject><subject>Human health and pathology</subject><subject>Ischemia</subject><subject>Life Sciences</subject><subject>Medical Imaging</subject><subject>Nuclear medicine</subject><subject>Occlusion</subject><subject>Patients</subject><subject>Subgroups</subject><subject>Thrombolysis</subject><issn>0364-5134</issn><issn>1531-8249</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kEtr3DAURkVpaSZpF_0DRdBVF070sGWpO3fIozBJCk3X4o50TRw01lSyEubfx8mk6aqrCx-Hw-UQ8omzY86YOIERjkXTcvWGLHgjeaVFbd6SBZOqrhou6wNymPMdY8wozt6TAym4blvOFwS_hxg9_Zkw55KQnkcImcLo6TIM4-Ag0OsyubjBee0nTPRXcW6G-xLo6ejjPWRXAiR6c4sJtrtvtKOXJUyDw_EZn4rffSDv-tmLH1_uEfl9dnqzvKhW1-c_lt2qclK3qmrAMIDaG4WNdqC9rFEKZyTTHAXi2mvXA9Z9C940RvfGIxqzRoau5ejlEfm6995CsNs0bCDtbITBXnQr-7QxKZRWytzzmf2yZ7cp_imYJ3sXSxrn96yoWSMYV7L-Z3Qp5pywf9VyZp_i2zm-fY4_s59fjGW9Qf9K_q09Ayd74GEIuPu_yXZX3V75CPZNjls</recordid><startdate>202006</startdate><enddate>202006</enddate><creator>Anadani, Mohammad</creator><creator>Arthur, Adam S.</creator><creator>Tsivgoulis, Georgios</creator><creator>Simpson, Kit N.</creator><creator>Alawieh, Ali</creator><creator>Orabi, Yser</creator><creator>Goyal, Nitin</creator><creator>Alexandrov, Andrei V.</creator><creator>Maier, Ilko L.</creator><creator>Psychogios, Marios‐Nikos</creator><creator>Liman, Jan</creator><creator>Brinton, Daniel</creator><creator>Swisher, Christa B.</creator><creator>Shah, Shreyash</creator><creator>Inamullah, Ovais</creator><creator>Keyrouz, Salah</creator><creator>Kansagra, Akash P.</creator><creator>Allen, Michelle</creator><creator>Giles, James A.</creator><creator>Wolfe, Stacey Q.</creator><creator>Fargen, Kyle M.</creator><creator>Gory, Benjamin</creator><creator>De Marini, Pierre</creator><creator>Kan, Peter</creator><creator>Nascimento, Fábio A.</creator><creator>Almallouhi, Eyad</creator><creator>Petersen, Nils</creator><creator>Kodali, Sreeja</creator><creator>Rahman, Shareena</creator><creator>Richard, Sébastien</creator><creator>Spiotta, Alejandro M.</creator><general>John Wiley & Sons, Inc</general><general>Wiley Subscription Services, Inc</general><general>Wiley</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>1XC</scope><orcidid>https://orcid.org/0000-0002-7813-2949</orcidid><orcidid>https://orcid.org/0000-0002-0640-3797</orcidid><orcidid>https://orcid.org/0000-0001-8441-6326</orcidid><orcidid>https://orcid.org/0000-0001-5059-4095</orcidid><orcidid>https://orcid.org/0000-0001-8424-4464</orcidid><orcidid>https://orcid.org/0000-0002-0945-5656</orcidid></search><sort><creationdate>202006</creationdate><title>Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study</title><author>Anadani, Mohammad ; Arthur, Adam S. ; Tsivgoulis, Georgios ; Simpson, Kit N. ; Alawieh, Ali ; Orabi, Yser ; Goyal, Nitin ; Alexandrov, Andrei V. ; Maier, Ilko L. ; Psychogios, Marios‐Nikos ; Liman, Jan ; Brinton, Daniel ; Swisher, Christa B. ; Shah, Shreyash ; Inamullah, Ovais ; Keyrouz, Salah ; Kansagra, Akash P. ; Allen, Michelle ; Giles, James A. ; Wolfe, Stacey Q. ; Fargen, Kyle M. ; Gory, Benjamin ; De Marini, Pierre ; Kan, Peter ; Nascimento, Fábio A. ; Almallouhi, Eyad ; Petersen, Nils ; Kodali, Sreeja ; Rahman, Shareena ; Richard, Sébastien ; Spiotta, Alejandro M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3876-5a90aa4d96e58ca8d34e32c93081e2eebd8cfae4f7ad9598f9dee99be0ec71ed3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Bioengineering</topic><topic>Blood pressure</topic><topic>Blood vessels</topic><topic>Cardiovascular system</topic><topic>Cerebral blood flow</topic><topic>Clinical outcomes</topic><topic>Computer Science</topic><topic>Hemorrhage</topic><topic>Human health and pathology</topic><topic>Ischemia</topic><topic>Life Sciences</topic><topic>Medical Imaging</topic><topic>Nuclear medicine</topic><topic>Occlusion</topic><topic>Patients</topic><topic>Subgroups</topic><topic>Thrombolysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Anadani, Mohammad</creatorcontrib><creatorcontrib>Arthur, Adam S.</creatorcontrib><creatorcontrib>Tsivgoulis, Georgios</creatorcontrib><creatorcontrib>Simpson, Kit N.</creatorcontrib><creatorcontrib>Alawieh, Ali</creatorcontrib><creatorcontrib>Orabi, Yser</creatorcontrib><creatorcontrib>Goyal, Nitin</creatorcontrib><creatorcontrib>Alexandrov, Andrei V.</creatorcontrib><creatorcontrib>Maier, Ilko L.</creatorcontrib><creatorcontrib>Psychogios, Marios‐Nikos</creatorcontrib><creatorcontrib>Liman, Jan</creatorcontrib><creatorcontrib>Brinton, Daniel</creatorcontrib><creatorcontrib>Swisher, Christa B.</creatorcontrib><creatorcontrib>Shah, Shreyash</creatorcontrib><creatorcontrib>Inamullah, Ovais</creatorcontrib><creatorcontrib>Keyrouz, Salah</creatorcontrib><creatorcontrib>Kansagra, Akash P.</creatorcontrib><creatorcontrib>Allen, Michelle</creatorcontrib><creatorcontrib>Giles, James A.</creatorcontrib><creatorcontrib>Wolfe, Stacey Q.</creatorcontrib><creatorcontrib>Fargen, Kyle M.</creatorcontrib><creatorcontrib>Gory, Benjamin</creatorcontrib><creatorcontrib>De Marini, Pierre</creatorcontrib><creatorcontrib>Kan, Peter</creatorcontrib><creatorcontrib>Nascimento, Fábio A.</creatorcontrib><creatorcontrib>Almallouhi, Eyad</creatorcontrib><creatorcontrib>Petersen, Nils</creatorcontrib><creatorcontrib>Kodali, Sreeja</creatorcontrib><creatorcontrib>Rahman, Shareena</creatorcontrib><creatorcontrib>Richard, Sébastien</creatorcontrib><creatorcontrib>Spiotta, Alejandro M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Hyper Article en Ligne (HAL)</collection><jtitle>Annals of neurology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Anadani, Mohammad</au><au>Arthur, Adam S.</au><au>Tsivgoulis, Georgios</au><au>Simpson, Kit N.</au><au>Alawieh, Ali</au><au>Orabi, Yser</au><au>Goyal, Nitin</au><au>Alexandrov, Andrei V.</au><au>Maier, Ilko L.</au><au>Psychogios, Marios‐Nikos</au><au>Liman, Jan</au><au>Brinton, Daniel</au><au>Swisher, Christa B.</au><au>Shah, Shreyash</au><au>Inamullah, Ovais</au><au>Keyrouz, Salah</au><au>Kansagra, Akash P.</au><au>Allen, Michelle</au><au>Giles, James A.</au><au>Wolfe, Stacey Q.</au><au>Fargen, Kyle M.</au><au>Gory, Benjamin</au><au>De Marini, Pierre</au><au>Kan, Peter</au><au>Nascimento, Fábio A.</au><au>Almallouhi, Eyad</au><au>Petersen, Nils</au><au>Kodali, Sreeja</au><au>Rahman, Shareena</au><au>Richard, Sébastien</au><au>Spiotta, Alejandro M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study</atitle><jtitle>Annals of neurology</jtitle><addtitle>Ann Neurol</addtitle><date>2020-06</date><risdate>2020</risdate><volume>87</volume><issue>6</issue><spage>830</spage><epage>839</epage><pages>830-839</pages><issn>0364-5134</issn><eissn>1531-8249</eissn><abstract><![CDATA[Objective
Elevated systolic blood pressure (SBP) after successful revascularization (SR) via endovascular therapy (EVT) is a known predictor of poor outcome. However, the optimal SBP goal following EVT is still unknown. Our objective was to compare functional and safety outcomes between different SBP goals after EVT with SR.
Methods
This international multicenter study included 8 comprehensive stroke centers and patients with anterior circulation large vessel occlusion who were treated with EVT and achieved SR. SR was defined as modified thrombolysis in cerebral ischemia 2b to 3. Patients were divided into 3 groups based on SBP goal in the first 24 hours after EVT. Inverse probability of treatment weighting (IPTW) propensity analysis was used to assess the effect of different SBP goals on clinical outcomes.
Results
A total of 1,019 patients were included. On IPTW analysis, the SBP goal of <140mmHg was associated with a higher likelihood of good functional outcome and lower odds of hemicraniectomy compared to SBP goal of <180mmHg. Similarly, SBP goal of <160mmHg was associated with lower odds of mortality compared to SBP goal of <180mmHg. In subgroup analysis including only patients with pre‐EVT SBP of ≥140mmHg, an SBP of <140mmHg was associated with a higher likelihood of good functional outcome, lower odds of symptomatic intracranial hemorrhage, and lower odds of requirement for hemicraniectomy compared to SBP goal of <180mmHg.
Interpretation
SBP goals of <140 and < 160mmHg following SR with EVT appear to be associated with better clinical outcomes than SBP of <180mmHg. ANN NEUROL 2020;87:830–839]]></abstract><cop>Hoboken, USA</cop><pub>John Wiley & Sons, Inc</pub><pmid>32187711</pmid><doi>10.1002/ana.25716</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7813-2949</orcidid><orcidid>https://orcid.org/0000-0002-0640-3797</orcidid><orcidid>https://orcid.org/0000-0001-8441-6326</orcidid><orcidid>https://orcid.org/0000-0001-5059-4095</orcidid><orcidid>https://orcid.org/0000-0001-8424-4464</orcidid><orcidid>https://orcid.org/0000-0002-0945-5656</orcidid></addata></record> |
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| source | Wiley-Blackwell Journals |
| subjects | Bioengineering Blood pressure Blood vessels Cardiovascular system Cerebral blood flow Clinical outcomes Computer Science Hemorrhage Human health and pathology Ischemia Life Sciences Medical Imaging Nuclear medicine Occlusion Patients Subgroups Thrombolysis |
| title | Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study |
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