Transport Blood Pressures and Outcomes in Stroke Patients Requiring Thrombectomy

• Published in: Air medical journal 2020-05, Vol.39 (3), p.166-172
• Main Authors: Shriki, Jesse, Johnson, Lashaunda, Patel, Priya, McGann, Madison, Lurie, Tucker, Phipps, Michael S., Yarbrough, Karen, Jindal, Gaurav, Mubariz, Hassan, Galvagno, Samuel M., Thom, Stephen R., Tran, Quincy K.
• Format: Article
• Language: English
• Subjects: Health administration
• ISSN: 1067-991X; 1532-6497
• DOI: 10.1016/j.amj.2020.03.002

•Mechanical thrombectomy is the treatment of choice for acute ischemic strokes from large vessel occlusions.•Blood pressure variability was similar between patients with good and bad functional independence.•The benefit of mechanical thrombectomy may overshadow the effect of blood pressure variability.•Higher systolic blood pressure during transport was associated with a low likelihood of a modified Rankin Scale score ≤2.•Maximum systolic blood pressure was not found to correlated with acute kidney injury. Mechanical thrombectomy is the treatment of choice for acute ischemic strokes from large vessel occlusions. Absolute blood pressure and blood pressure variability (BPV) may affect patients’ outcome. We hypothesized that patients’ outcomes were not associated with BPV during transport between hospitals in the era of effective thrombectomy. We performed a retrospective observational review of adult patients admitted to our comprehensive stroke center who underwent mechanical thrombectomy between January 1, 2015, and December 31, 2018. Data were collected from our stroke registry and transportation records. Outcomes were defined as 90-day modified Rankin Scale (mRS) ≤2 and any acute kidney injury (AKI) during hospitalization. We analyzed 134 eligible patients. The mean age was 66 years (standard deviation = 14 years). Forty percent achieved mRS ≤2, and 16% had an AKI. BPV and maximum systolic blood pressures during transport were examined as variables to determine outcome. We found BPV was similar between patients with good and bad functional independence. Furthermore, the maximum systolic blood pressure during transport (odds ratio = 0.98; 95% confidence interval, 0.96-0.99; P = .038), not BPV, was associated with a lower likelihood of mRS ≤2. No similar correlation of analyzed blood pressure variables could be found for AKI as an outcome. The maximum systolic blood pressure was associated with worse functional outcomes in stroke patients transported for thrombectomy. Prehospital clinicians should be cognizant of high blood pressure among patients with acute ischemic stroke from large vessel occlusion during transport and treat accordingly.