A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia. (12th April 2017)

• Record Type: Journal Article
• Authors: Treurniet, Kilian M; Berkhemer, Olvert A; Immink, Rogier V; Lingsma, Hester F; Ward-van der Stam, Vivian M C; Hollmann, Markus W; Vuyk, Jaap; van Zwam, Wim H; van der Lugt, Aad; van Oostenbrugge, Robert J; Dippel, Diederik W J; Coutinho, Jonathan M; Roos, Yvo B W E M; Marquering, Henk A; Majoie, Charles B L M
• Other Names: author non-byline.; Dippel Diederik W J author non-byline.; Lugt Aad van der author non-byline.; Majoie Charles B L M author non-byline.; Roos Yvo B W E M author non-byline.; van Oostenbrugge Robert J author non-byline.; van Zwam Wim H author non-byline.; Berkhemer Olvert A author non-byline.; Fransen Puck S S author non-byline.; Beumer Debbie author non-byline.; van den Berg Lucie A author non-byline.; Schonewille Wouter J author non-byline.; Vos Jan Albert author non-byline.; Majoie Charles B L M author non-byline.; Roos Yvo B W E M author non-byline.; Nederkoorn Paul J author non-byline.; Wermer Marieke J H author non-byline.; Walderveen Marianne A A van author non-byline.; van Oostenbrugge Robert J author non-byline.; van Zwam Wim H author non-byline.; Staals Julie author non-byline.; Hofmeijer Jeannette author non-byline.; van Oostayen Jacques A author non-byline.; Nijeholt Geert J Lycklama à author non-byline.; Boiten Jelis author non-byline.; Dippel Diederik W J author non-byline.; Brouwer Patrick A author non-byline.; Emmer Bart J author non-byline.; de Bruijn Sebastiaan F author non-byline.; van Dijk Lukas C author non-byline.; Kappelle L Jaap author non-byline.; Lo Rob H author non-byline.; van Dijk Ewoud J author non-byline.; de Vries Joost author non-byline.; de Kort Paul L M author non-byline.; van den Berg Jan S P author non-byline.; van Rooij Willem Jan J author non-byline.; van Hasselt Boudewijn A A M author non-byline.; Aerden Leo A M author non-byline.; Dallinga René J author non-byline.; Visser Marieke C author non-byline.; Bot Joseph C J author non-byline.; Vroomen Patrick C author non-byline.; Eshghi Omid author non-byline.; Schreuder Tobien H C M L author non-byline.; Heijboer Roel J J author non-byline.; Keizer Koos author non-byline.; Tielbeek Alexander V author non-byline.; Hertog Heleen M den author non-byline.; Gerrits Dick G author non-byline.; van den Berg-Vos Renske M author non-byline.; Karas Giorgos B author non-byline.; Majoie Charles B L M author non-byline.; van Zwam Wim H author non-byline.; van der Lugt Aad author non-byline.; Nijeholt Geert J Lycklama à author non-byline.; van Walderveen Marianne A A author non-byline.; Bot Joseph C J author non-byline.; Marquering Henk A author non-byline.; Beenen Ludo F author non-byline.; Sprengers Marieke E S author non-byline.; Jenniskens Sjoerd F M author non-byline.; van den Berg René author non-byline.; Berkhemer Olvert A author non-byline.; Yoo Albert J author non-byline.; Roos Yvo B W E M author non-byline.; Koudstaal Peter J author non-byline.; Boiten Jelis author non-byline.; van Dijk Ewoud J. author non-byline.; van Oostenbrugge Robert J author non-byline.; Wermer Marieke J H author non-byline.; Flach H Zwenneke author non-byline.; Steyerberg Ewout W author non-byline.; Lingsma Hester F author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 10:Number 2(2018)
• Page Start: 107
• Page End: 111
• Publication Date: 2017-04-12
• Subjects: Thrombectomy -- Stroke -- Blood Pressure; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2017-012988
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Up to two-thirds of patients are either dependent or dead 3 months after thrombectomy for acute ischemic stroke (AIS). Loss of cerebral autoregulation may render patients with AIS vulnerable to decreases in mean arterial pressure (MAP). Objective: To determine whether a fall in MAP during intervention under general anesthesia (GA) affects functional outcome. Methods: This subgroup analysis included patients from the MR CLEAN trial treated with thrombectomy under GA. The investigated variables were the difference between MAP at baseline and average MAP during GA (ΔMAP) as well as the difference between baseline MAP and the lowest MAP during GA (ΔLMAP). Their association with a shift towards better outcome on the modified Rankin Scale (mRS) after 90 days was determined using ordinal logistic regression with adjustment for prognostic baseline variables. Results: Sixty of the 85 patients treated under GA in MR CLEAN had sufficient anesthetic information available for the analysis. A greater ΔMAP was associated with worse outcome (adjusted common OR (acOR) 0.95 per point mm Hg, 95% CI 0.92 to 0.99). An average MAP during GA 10 mm Hg lower than baseline MAP constituted a 1.67 times lower odds of a shift towards good outcome on the mRS. For ΔLMAP this association was not significant (acOR 0.97 per mm Hg, 95% CI 0.94 to 1.00, p=0.09). Conclusions: A decrease in MAP during intervention under GA compared with baseline is associated with worse outcome. Trial registration number: NTR1804 ; ISRCTN10888758 ; post-results.