Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion
Background: Current guidelines advocate for maintaining BP level below 180/105 mmHg during EVT, determining the safe lower boundary remains primarily consensus-driven by experts. This study aims to delve into the correlation between various targets of lower boundary for systolic and diastolic BP (SB...
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Elsevier
2025-03-01
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| Series: | Journal of the Formosan Medical Association |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S0929664624002390 |
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| author | Yu-Ming Chang Chun-Min Wang Kang-Po Lee Po-Chun Shen Po-Yu Lin Chi-Hung Liu Sheng-Hsiang Lin Chih-Hung Chen Meng-Tsang Hsieh Pi-Shan Sung |
| author_facet | Yu-Ming Chang Chun-Min Wang Kang-Po Lee Po-Chun Shen Po-Yu Lin Chi-Hung Liu Sheng-Hsiang Lin Chih-Hung Chen Meng-Tsang Hsieh Pi-Shan Sung |
| author_sort | Yu-Ming Chang |
| collection | DOAJ |
| description | Background: Current guidelines advocate for maintaining BP level below 180/105 mmHg during EVT, determining the safe lower boundary remains primarily consensus-driven by experts. This study aims to delve into the correlation between various targets of lower boundary for systolic and diastolic BP (SBP and DBP) during EVT and 3-month functional outcomes. Methods: A cohort study was conducted across two EVT-capable centers, enrolling patients with large artery occlusion undergoing EVT within 8 h of stroke onset. Mean BP values during EVT were meticulously recorded, and logistic regression models were utilized to evaluate the correlation between outcomes and diverse lower boundary targets for SBP and DBP. Additionally, logistic regression models investigated the relationship between periprocedural BP variability and subsequent outcomes. Results: Among the 201 patients included, having a SBP higher than 130 or 140 mmHg showed an independent association with increased good functional outcomes at 3 months (adjusted odds ratio, aOR 2.80, 95% Cis, 1.26–6.39 for 140 mmHg; aOR 2.34, 95% Cis, 1.03–5.56 for 130 mmHg). Additionally, an SBP exceeding 130 mmHg was correlated with decreased 3-month mortality (aOR, 0.24, 95% CI 0.07–0.74). No significant relationship was observed between DBP and functional outcomes. Patients with higher periprocedural SBP coefficient variance exhibited a decreased rate of good functional outcomes at 3 months (aOR, 0.42, 95% CI, 0.18–0.96). Conclusion: A SBP range above 130–140 mmHg could potentially serve as a safe lower boundary during EVT, while minimizing BP fluctuations may correlate with improved post-EVT functional outcomes. |
| format | Article |
| id | doaj-art-c0c7b03b45894c1c9f6edb261e90cf7c |
| institution | DOAJ |
| issn | 0929-6646 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the Formosan Medical Association |
| spelling | doaj-art-c0c7b03b45894c1c9f6edb261e90cf7c2025-08-20T02:47:49ZengElsevierJournal of the Formosan Medical Association0929-66462025-03-01124327828310.1016/j.jfma.2024.05.003Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusionYu-Ming Chang0Chun-Min Wang1Kang-Po Lee2Po-Chun Shen3Po-Yu Lin4Chi-Hung Liu5Sheng-Hsiang Lin6Chih-Hung Chen7Meng-Tsang Hsieh8Pi-Shan Sung9Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Neurology, Tainan SinLau Hospital, Tainan, Taiwan; Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Neurology, Chia-Yi Hospital, Ministry of Health and Welfare, Chia-Yi, TaiwanDepartment of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanStroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan; Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, TaiwanInstitute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, TaiwanDepartment of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanInstitute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Stroke Center and Department of Neurology, Chi-Mei Medical Center, Tainan, Taiwan; School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; Corresponding author. No. 1, Yida Rd., Yanchao Dist., Kaohsiung City, 824005, Taiwan.Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Corresponding author. No. 138, Sheng Li Road, Tainan city, 704, Taiwan.Background: Current guidelines advocate for maintaining BP level below 180/105 mmHg during EVT, determining the safe lower boundary remains primarily consensus-driven by experts. This study aims to delve into the correlation between various targets of lower boundary for systolic and diastolic BP (SBP and DBP) during EVT and 3-month functional outcomes. Methods: A cohort study was conducted across two EVT-capable centers, enrolling patients with large artery occlusion undergoing EVT within 8 h of stroke onset. Mean BP values during EVT were meticulously recorded, and logistic regression models were utilized to evaluate the correlation between outcomes and diverse lower boundary targets for SBP and DBP. Additionally, logistic regression models investigated the relationship between periprocedural BP variability and subsequent outcomes. Results: Among the 201 patients included, having a SBP higher than 130 or 140 mmHg showed an independent association with increased good functional outcomes at 3 months (adjusted odds ratio, aOR 2.80, 95% Cis, 1.26–6.39 for 140 mmHg; aOR 2.34, 95% Cis, 1.03–5.56 for 130 mmHg). Additionally, an SBP exceeding 130 mmHg was correlated with decreased 3-month mortality (aOR, 0.24, 95% CI 0.07–0.74). No significant relationship was observed between DBP and functional outcomes. Patients with higher periprocedural SBP coefficient variance exhibited a decreased rate of good functional outcomes at 3 months (aOR, 0.42, 95% CI, 0.18–0.96). Conclusion: A SBP range above 130–140 mmHg could potentially serve as a safe lower boundary during EVT, while minimizing BP fluctuations may correlate with improved post-EVT functional outcomes.http://www.sciencedirect.com/science/article/pii/S0929664624002390Acute ischemic strokeEndovascular thrombectomyPeriprocedural blood pressureBlood pressure variability |
| spellingShingle | Yu-Ming Chang Chun-Min Wang Kang-Po Lee Po-Chun Shen Po-Yu Lin Chi-Hung Liu Sheng-Hsiang Lin Chih-Hung Chen Meng-Tsang Hsieh Pi-Shan Sung Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion Journal of the Formosan Medical Association Acute ischemic stroke Endovascular thrombectomy Periprocedural blood pressure Blood pressure variability |
| title | Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion |
| title_full | Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion |
| title_fullStr | Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion |
| title_full_unstemmed | Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion |
| title_short | Exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion |
| title_sort | exploring the optimal lower blood pressure boundary during endovascular thrombectomy in patients with large vessel occlusion |
| topic | Acute ischemic stroke Endovascular thrombectomy Periprocedural blood pressure Blood pressure variability |
| url | http://www.sciencedirect.com/science/article/pii/S0929664624002390 |
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