Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study

Mohammad Anadani; Adam S. Arthur; Georgios Tsivgoulis; Kit N. Simpson; Ali Alawieh; Yser Orabi; Nitin Goyal; Andrei V. Alexandrov; Ilko L. Maier; Marios Nikos Psychogios; Jan Liman; Daniel Brinton; Christa B. Swisher; Shreyash Shah; Ovais Inamullah; Salah Keyrouz; Akash P. Kansagra; Michelle Allen; James A. Giles; Stacey Q. Wolfe; Kyle M. Fargen; Benjamin Gory; Pierre De Marini; Peter Kan; Fábio A. Nascimento; Eyad Almallouhi; Nils Petersen; Sreeja Kodali; Shareena Rahman; Sébastien Richard; Alejandro M. Spiotta

doi:10.1002/ana.25716

Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study

Mohammad Anadani, Adam S. Arthur, Georgios Tsivgoulis, Kit N. Simpson, Ali Alawieh, Yser Orabi, Nitin Goyal, Andrei V. Alexandrov, Ilko L. Maier, Marios Nikos Psychogios, Jan Liman, Daniel Brinton, Christa B. Swisher, Shreyash Shah, Ovais Inamullah, Salah Keyrouz, Akash P. Kansagra, Michelle Allen, James A. Giles, Stacey Q. WolfeKyle M. Fargen, Benjamin Gory, Pierre De Marini, Peter Kan, Fábio A. Nascimento, Eyad Almallouhi, Nils Petersen, Sreeja Kodali, Shareena Rahman, Sébastien Richard, Alejandro M. Spiotta

Research output: Contribution to journal › Article › peer-review

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Abstract

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.

Original language	English (US)
Pages (from-to)	830-839
Number of pages	10
Journal	Annals of Neurology
Volume	87
Issue number	6
DOIs	https://doi.org/10.1002/ana.25716
State	Published - Jun 1 2020
Externally published	Yes

ASJC Scopus subject areas

Neurology
Clinical Neurology

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Anadani, M., Arthur, A. S., Tsivgoulis, G., Simpson, K. N., Alawieh, A., Orabi, Y., Goyal, N., Alexandrov, A. V., Maier, I. L., Psychogios, M. N., Liman, J., Brinton, D., Swisher, C. B., Shah, S., Inamullah, O., Keyrouz, S., Kansagra, A. P., Allen, M., Giles, J. A., ... Spiotta, A. M. (2020). Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study. Annals of Neurology, 87(6), 830-839. https://doi.org/10.1002/ana.25716

Anadani, M, Arthur, AS, Tsivgoulis, G, Simpson, KN, Alawieh, A, Orabi, Y, Goyal, N, Alexandrov, AV, Maier, IL, Psychogios, MN, Liman, J, Brinton, D, Swisher, CB, Shah, S, Inamullah, O, Keyrouz, S, Kansagra, AP, Allen, M, Giles, JA, Wolfe, SQ, Fargen, KM, Gory, B, De Marini, P, Kan, P, Nascimento, FA, Almallouhi, E, Petersen, N, Kodali, S, Rahman, S, Richard, S & Spiotta, AM 2020, 'Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study', Annals of Neurology, vol. 87, no. 6, pp. 830-839. https://doi.org/10.1002/ana.25716

@article{033d954bec414c8c86f016a4ae88f08e,

title = "Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study",

abstract = "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.",

author = "Mohammad Anadani and Arthur, {Adam S.} and Georgios Tsivgoulis and Simpson, {Kit N.} and Ali Alawieh and Yser Orabi and Nitin Goyal and Alexandrov, {Andrei V.} and Maier, {Ilko L.} and Psychogios, {Marios Nikos} and Jan Liman and Daniel Brinton and Swisher, {Christa B.} and Shreyash Shah and Ovais Inamullah and Salah Keyrouz and Kansagra, {Akash P.} and Michelle Allen and Giles, {James A.} and Wolfe, {Stacey Q.} and Fargen, {Kyle M.} and Benjamin Gory and {De Marini}, Pierre and Peter Kan and Nascimento, {F{\'a}bio A.} and Eyad Almallouhi and Nils Petersen and Sreeja Kodali and Shareena Rahman and S{\'e}bastien Richard and Spiotta, {Alejandro M.}",

note = "Publisher Copyright: {\textcopyright} 2020 American Neurological Association",

year = "2020",

month = jun,

day = "1",

doi = "10.1002/ana.25716",

language = "English (US)",

volume = "87",

pages = "830--839",

journal = "Annals of Neurology",

issn = "0364-5134",

publisher = "John Wiley and Sons Inc.",

number = "6",

}

TY - JOUR

T1 - Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy

T2 - A Multicenter Study

AU - Anadani, Mohammad

AU - Arthur, Adam S.

AU - Tsivgoulis, Georgios

AU - Simpson, Kit N.

AU - Alawieh, Ali

AU - Orabi, Yser

AU - Goyal, Nitin

AU - Alexandrov, Andrei V.

AU - Maier, Ilko L.

AU - Psychogios, Marios Nikos

AU - Liman, Jan

AU - Brinton, Daniel

AU - Swisher, Christa B.

AU - Shah, Shreyash

AU - Inamullah, Ovais

AU - Keyrouz, Salah

AU - Kansagra, Akash P.

AU - Allen, Michelle

AU - Giles, James A.

AU - Wolfe, Stacey Q.

AU - Fargen, Kyle M.

AU - Gory, Benjamin

AU - De Marini, Pierre

AU - Kan, Peter

AU - Nascimento, Fábio A.

AU - Almallouhi, Eyad

AU - Petersen, Nils

AU - Kodali, Sreeja

AU - Rahman, Shareena

AU - Richard, Sébastien

AU - Spiotta, Alejandro M.

PY - 2020/6/1

Y1 - 2020/6/1

N2 - 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.

AB - 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.

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U2 - 10.1002/ana.25716

DO - 10.1002/ana.25716

M3 - Article

C2 - 32187711

AN - SCOPUS:85082933837

SN - 0364-5134

VL - 87

SP - 830

EP - 839

JO - Annals of Neurology

JF - Annals of Neurology

IS - 6

ER -

Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study

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