Blood pressure reduction and outcome after endovascular therapy with successful reperfusion: A multicenter study

Mohammad Anadani, Adam S. Arthur, Ali Alawieh, Yser Orabi, Andrei Alexandrov, Nitin Goyal, Marios Nikos Psychogios, Ilko Maier, Joon Tae Kim, Saleh G. Keyrouz, Adam De Havenon, Nils H. Petersen, Abhi Pandhi, Christa B. Swisher, Ovais Inamullah, Jan Liman, Sreeja Kodali, James A. Giles, Michelle Allen, Stacey Q. WolfeGeorgios Tsivgoulis, Bradley A. Cagle, Chesney S. Oravec, Benjamin Gory, Pierre De Marini, Peter Kan, Shareena Rahman, Sébastien Richard, Fábio A. Nascimento, Alejandro Spiotta

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Background Elevated systolic blood pressure (SBP) after mechanical thrombectomy (MT) correlates with worse outcome. However, the association between SBP reduction (SBPr) and outcome after successful reperfusion with MT is not well established. Objective To investigate the association between SBPr in the first 24 hours after successful reperfusion and the functional and safety outcomes of MT. Methods A multicenter retrospective study, which included 10 comprehensive stroke centers, was carried out. Patients with acute ischemic stroke and anterior circulation large vessel occlusions who achieved successful reperfusion via MT were included. SBPr was calculated using the formula 100×([admission SBP-mean SBP]/admission SBP). Poor outcome was defined as a modified Rankin Scale (mRS) score of 3-6 at 90 days. Safety endpoints included symptomatic intracerebral hemorrhage, mortality, and requirement for hemicraniectomy during admission. A generalized mixed linear model was used to study the association between SBPr and outcomes. Results A total of 1361 patients were included in the final analysis. SBPr as a continuous variable was inversely associated with poor outcome (OR=0.97; 95% CI 0.95 to 0.98; p<0.001) but not with the safety outcomes. Subanalysis based on reperfusion status showed that SBPr was associated with lower odds of poor outcome only in patients with complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI 3)) but not in patients with incomplete reperfusion (mTICI 2b). When SBPr was divided into categories (<1%, 1%-10%, 11%-20%, >20%), the rate of poor outcome was highest in the first group. Conclusion SBPr in the first 24 hours after successful reperfusion was inversely associated with poor outcome. No association between SBPr and safety outcome was found.

Original languageEnglish (US)
Pages (from-to)932-936
Number of pages5
JournalJournal of neurointerventional surgery
Issue number10
StatePublished - Oct 1 2020
Externally publishedYes


  • blood pressure
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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