Authors:	Hahn, Marianne Hayani, Eyad Bitar, Lynn Gröschel, Sonja Steffen, Falk Protopapa, Maria Othman, Ahmed Bittner, Stefan Zipp, Frauke Gröschel, Klaus Uphaus, Timo
Title:	Strict blood pressure control following thrombectomy is associated with neuronal injury and poor functional outcome
Online publication date:	26-Jan-2024
Year of first publication:	2023
Language:	english
Abstract:	Objective Mechanical thrombectomy (MT) has become standard treatment in acute ischemic stroke due to large vessel occlusion (LVO). However, optimal blood pressure (BP) management following successful recanalization remains unclear. We aim to investigate the association of strictly achieving BP targets of ≤160/90 mmHg with the extent of neuronal loss and functional outcome. Methods In patients prospectively enrolled in the Gutenberg-Stroke-Study (May 2018–November 2019), BP was measured half-hourly for 24 h following MT. Based on achieving BP target of ≤160/90 mmHg, patients with successful recanalization of LVO were divided into “low-BP” group (BP ≤ 160/90 mmHg) or “high-BP” group (BP > 160/90 mmHg). Neuronal loss was quantified by serum-based measurement of neurofilament light chain (sNfL) after three days. BP groups and association of BP parameters with sNfL were investigated by correlation analyses and multiple regression modeling. Results Of 253 enrolled patients (mean age 73.1 ± 12.9 years, 53.4% female), 165 met inclusion criteria. 21.2% (n = 35) strictly achieved “low-BP” target. “low-BP” was associated with unfavorable functional outcome at 90-day follow-up (aOR [95%CI]: 5.88 [1.88–18.32], p = 0.002) and decreased health-related quality of life (mean EQ-5D-index 0.45 ± 0.28 vs 0.63 ± 0.31, p = 0.009). sNfL levels were increased in “low-BP” patients (median [IQR] 239.7 [168.4–303.4] vs 118.8 [52.5–220.5] pg/mL, p = 0.026). Hypotensive episodes were more frequent in the “low-BP” group (48.6% vs 29.2%, p = 0.031). sNfL level could identify patients who had experienced hypotensive episodes with high discriminative ability (AUC [95%CI]: 0.68 [0.56–0.78], p = 0.007). Interpretation Strict BP control (≤160/90 mmHg) within 24 h following successful recanalization of LVO by MT is associated with increased neuronal injury, displayed by higher sNfL levels, and poorer functional outcome, potentially indicating hypotension-induced neuronal loss during post-MT phase.
DDC:	610 Medizin 610 Medical sciences
Institution:	Johannes Gutenberg-Universität Mainz
Department:	FB 04 Medizin
Place:	Mainz
ROR:	https://ror.org/023b0x485
DOI:	http://doi.org/10.25358/openscience-9979
Version:	Published version
Publication type:	Zeitschriftenaufsatz
Document type specification:	Scientific article
License:	CC BY-NC-ND
Information on rights of use:	https://creativecommons.org/licenses/by-nc-nd/4.0/
Journal:	Annals of Clinical and Translational Neurology 10 12
Pages or article number:	2255 2265
Publisher:	Wiley
Publisher place:	Chichester u.a.
Issue date:	2023
ISSN:	2328-9503
Publisher DOI:	10.1002/acn3.51909
Appears in collections:	DFG-491381577-G