Systolic blood pressure before reperfusion and infarct growth in patients with acute stroke treated with thrombectomy

Background Mechanical thrombectomy (MT) is highly effective for acute large-vessel occlusion. Evidence on how systolic blood pressure (SBP) should be managed in the periprocedural period, especially before reperfusion, is limited. The aims of the present study were to clarify the associations between BP before reperfusion and infarct growth (IG) on diffusion-weighted imaging (DWI) in consecutive acute stroke patients treated with MT. Methods Consecutive acute ischemic stroke patients treated with emergent MT were retrospectively enrolled. IG was defined as the difference between 24-hour and baseline DWI infarct volumes. The associations between SBP parameters before reperfusion (maximum, minimum, mean, coefficient of variation [CV], SBP drop indices [from SBP on arrival], and area below the arrival SBP) and IG were assessed using multivariable regression models. Results A total of 292 MT procedures in 287 patients (175 male [60%], median age 76 [IQR 68-83] years, median onset to DWI time 131 [80-326] minutes) were included in this study. Follow-up MRI was performed at a median of 22 [17-26] hours. On multivariable analyses, minimum SBP (standardized β -0.143, 95% confidence interval (CI) -0.254 to -0.032, p=0.012, i.e., low minimum SBP was associated with higher IG) and CV of SBP (0.157, 0.053 to 0.260, p = 0.003) were independently associated with IG. Conclusion In MT-treated acute ischemic stroke, lower minimum SBP and greater SBP variability before reperfusion were associated with larger early IG, supporting the avoidance of hypotension and excessive SBP fluctuations during hyperacute management before and during MT.