Abstract A079: Blood Pressure Changes Correlate With Radiological And Clinical Evolution Of Large Vessel Occlusion Stroke Patients Undergoing Prolonged Interhospital Transfer

Background: Despite recent advances in stroke care, endovascular thrombectomy (EVT) availability remains concentrated in metropolitan areas, and many patients with large vessel occlusions (LVO) strokes require interhospital transfer to receive EVT. It remains unclear how changes in blood pressure metrics in transit influence radiographic and clinical evolution. Methods: This was a retrospective study of LVO patients transferred to a comprehensive stroke center (CSC) for EVT within 1.5 to 6 hours of initial imaging. Clinical and radiographic data were collected at outside hospital and at CSC. Blood pressure (BP) metrics, including systolic blood pressure (SBP) and mean arterial pressure (MAP), were collected at the time of initial stroke imaging and upon arrival at CSC. BP changes were calculated as percentage deviations from initial measurements compared to measurements at CSC arrival. Primary outcomes were Alberta Stroke Programme Early Computed Tomography Score (ASPECTS) and NIH Stroke Scale (NIHSS) change from initial diagnosis to CSC arrival, adjusted for demographics, time from last known well, comorbidities, laboratory values, initial ASPECTS, initial NIHSS, intravenous thrombolysis (IVT) administration, transit time, and initial BP using multivariable linear regression analyses. Results: A total of 335 patients were included. Mean age was 68.5 years, 49.9% were male, 47.8% received IVT, and mean transit time was 199 minutes. Mean presenting SBP was 151.3 mmHg, and mean MAP was 107.1 mmHg. Mean ASPECTS decay was 2, and mean NIH stroke scale deterioration was 1.1. In multivariable regression analysis, change in SBP during transit was independently and significantly associated with ASPECTS decay (-0.48 per 20% decrease in SBP, p=0.003) and numerically associated with NIHSS worsening (+0.73 per 20% decrease in SBP, p=0.079). Similarly, change in MAP was associated with ASPECTS decay (-0.35 per 20% decrease in MAP, p=0.019) and NIHSS worsening (+0.82 per 20% decrease in SBP, p=0.030). Conclusions: Blood pressure changes during interhospital transfer for EVT are significantly associated with radiographic and clinical evolution of LVO stroke. BP decreases were associated with ASPECTS decay and NIHSS worsening. These findings have significant implications for BP management during EVT transfer, as well as clinical appropriateness of procedures such as endotracheal intubation and intravenous thrombolysis administration.