Even Small Decreases in Blood Pressure during Conscious Sedation Affect Clinical Outcome after Stroke Thrombectomy: An Analysis of Hemodynamic Thresholds

• DOI: 10.3174/ajnr.a4992
• Publication Date: 2016-11-03T21:49:52Z
• Authors: M.K. Whalin; K.M. Halenda; D.C. Haussen; L.C. Rebello; M.R. Frankel; R.Y. Gershon; R.G. Nogueira
• Keywords: Stroke; Mean arterial pressure

<h3>BACKGROUND AND PURPOSE:</h3> The adverse effects of general anesthesia in stroke thrombectomy have been attributed to intraprocedural hypotension, yet optimal hemodynamic targets remain elusive. Identifying thresholds from patients without exposure may help separate the effect hypotension outcomes. Therefore, we investigated which parameters and best correlate with outcome treated under sedation monitored care. <h3>MATERIALS METHODS:</h3> We performed a retrospective analysis prospectively collected data base anterior circulation who were successfully reperfused (modified TICI ≥ 2b) care 2010 2015. Receiver operating characteristic curves generated for lowest mean arterial pressure before reperfusion, both as absolute values relative changes baseline. Cutoffs tested binary logistic regression models poor (90-day mRS &gt; 2). <h3>RESULTS:</h3> Two-hundred fifty-six 714 met inclusion criteria. In multivariable model, ≥10% decrease baseline had an OR 4.38 (95% CI, 1.53–12.56; <i>P</i> &lt; .01). Other revealed that any &lt;85 mm Hg reperfusion 2.22 1.09–4.55; = .03) every 10-mm drop below 100 1.28 1.01–1.62; .04). <h3>CONCLUSIONS:</h3> A is strong risk factor homogeneous population undergoing sedation. This threshold could guide management during anesthesia.