Abstract WP210: Intraoperative Blood Pressure During Minimally Invasive Intracerebral Hemorrhage Evacuation Demonstrates Conflicting Effects on Postoperative Clinical Outcomes

Background: Spontaneous intracerebral hemorrhage (ICH) is a major cause of stroke-related disability and death. Blood pressure (BP) control is integral to ICH management. Current recommendations from the American Heart Association (AHA), European Stroke Organization (ESO), and other major institutions advocate for a rapid but controlled lowering of systolic BP to ~140 mmHg, while avoiding overshoot below 130 mmHg or large fluctuations. These guidelines primarily inform the treatment of ICH through conventional medical management. Recent research has presented minimally invasive surgery (MIS) as a promising approach to the treatment of ICH, however, intra-op BP targets during neurosurgical intervention remain poorly defined. Objective: To evaluate the relationship between intra-op BP management and postoperative clinical outcomes in patients who undergo MIS for the evacuation of an ICH. Methods: We retrospectively analyzed 49 patients (mean age 59.6 years) with spontaneous ICH who underwent MIS evacuation. The mean intra-op BP was calculated from continuous vitals monitoring. Clinical outcomes were determined based on ICU length of stay (LOS) and 3-month modified Rankin Scale (mRS). LOS relationships were evaluated with Pearson’s correlation (r) while mRS relationships were evaluated with Spearman’s rank correlation (rs). To reduce the effects of confounding variables, patients were stratified based on presenting ICH score: 0 (n=13), 1–2 (n=26), and 3–4 (n=10). There were no patients that presented with ICH scores > 4. Results: In patients with ICH scores 0 and 1–2, higher intraoperative BP demonstrated weak, non-significant correlations with ICU LOS (r = –0.384 and –0.287) and 3-month mRS (rs = –0.067 and –0.328). These results suggest that there may be a benefit to higher intra-op blood pressure for MIS ICH patients who present with an ICH score ≤ 2. In contrast, patients with ICH scores 3–4 showed intra-op BP was positively correlated with ICU LOS (r = 0.332) and strongly correlated with worse 3-month mRS(rs =0.792, p = 0.006). This suggests that more aggressive BP management may be beneficial for ICH patients with more severe prognoses. Conclusion: Mean intra-op BP demonstrated varied effects on clinical outcomes based on baseline severity. Ongoing efforts to expand the sample size and more rigorously control for confounding variables will help clarify optimal BP management strategies during MIS evacuation.