Abstract A080: Impact of blood pressure management after intravenous thrombolysis for large vessel occlusion patients undergoing interhospital transfer for endovascular thrombectomy

Introduction: Guidelines recommend use of intravenous thrombolysis (IVT) for eligible large vessel occlusion (LVO) stroke patients undergoing endovascular thrombectomy (EVT). For patients who require inter-hospital transfer for EVT, IVT may increase the odds of vessel recanalization prior to EVT; however, initiation of IVT may require blood pressure (BP) lowering, which could negatively impact patient outcomes if recanalization is not achieved. Methods: This was a retrospective cohort study of anterior circulation LVO patients who received IVT and were transferred to a comprehensive stroke center for EVT. Primary outcomes were rates of pre-EVT recanalization, use of BP lowering agents, and change in modified Rankin scale (mRS) at 90 days compared to pre-stroke baseline. BP at presentation and the lowest BP during inter-hospital transfer were recorded. Multivariable adjustments were performed for demographics, stroke location, comorbidities, stroke severity, baseline infarct burden, collateral status, and initial systolic BP (SBP). Results: Data was collected from 115 patients who received IVT and transferred for EVT. Mean age was 67.7 years, 60% were male. Overall, 35 (30.4%) achieved interim recanalization, which was associated with better 90-day outcomes (median mRS 1 vs. 2, p=0.004), sustained after multivariable adjustments (common odds ratio [cOR] of 2.59 [95%CI 1.05-6.58] for better 90-day mRS, p=0.041). At stroke presentation, the mean SBP was 151.6 mmHg, and 31 patients (27.0%) received BP lowering agents, leading to a mean 32.9 mmHg decrease in SBP, which was greater than the 16.4 mmHg decrease in the non-treated group (p=0.005). Receiving BP lowering agents was associated with worse 90-day outcomes (median mRS 3 vs. 2, p=0.002), and sustained association after multivariable adjustments (cOR 4.34 [95%CI 1.51-12.81] for worse 90-day mRS, p=0.007). BP lowering was associated with a lower rate of vessel recanalization (16.1% vs. 35.7%, p=0.043). Conclusions: Among LVO stroke patients who received IVT before interhospital transfer for EVT, 30.4% of patients achieved interim vessel recanalization, and 27.0% received BP lowering agents. While IVT-mediated vessel recanalization was associated with higher odds of better outcomes at 90-days, receiving BP lowering agents was associated with significantly worse outcomes and lower rates of IVT-mediated vessel recanalization. Future studies are needed to optimize post-IVT BP management for LVO stroke patients.