Baseline blood pressure does not modify the effect of intravenous thrombolysis in successfully revascularized patients

Zhang Xiaoxi, Zhu Xuan, Zhang Lei, Li Zifu, Xing Pengfei, Shen Hongjian, Zhang Yongxin, Hua Weilong, Zhou Yihan, Dai Dongwei, Li Qiang, Zhao Rui, Huang Qinghai, Xu Yi, Lili Song, Craig S Anderson, Liu Jianmin, Zhang Yongwei, Yang Pengfei, Zhang Xiaoxi, Zhu Xuan, Zhang Lei, Li Zifu, Xing Pengfei, Shen Hongjian, Zhang Yongxin, Hua Weilong, Zhou Yihan, Dai Dongwei, Li Qiang, Zhao Rui, Huang Qinghai, Xu Yi, Lili Song, Craig S Anderson, Liu Jianmin, Zhang Yongwei, Yang Pengfei

Abstract

Background: Studies indicate a trajectory relationship between baseline blood pressure (BP) and outcome in patients with acute ischemic stroke (AIS) eligible for both intravenous thrombolysis (IVT) with alteplase and endovascular treatment (EVT). We determined whether baseline BP modified the effect of IVT in successfully revascularized AIS patients who participated in the Direct Intra-Arterial Thrombectomy to Revascularize AIS Patients With Large Vessel Occlusion Efficiently in Chinese Tertiary Hospitals (DIECT-MT) trial.

Methods: The association of baseline systolic BP, trichotomized as high (141-185 mmHg), middle (121-140 mmHg), and low (91-120 mmHg), and the outcomes of any intracerebral hemorrhage (ICH), symptomatic ICH (sICH), and mortality and functional outcome on the modified Rankin scale at 90 days were explored. Logistic regression models determined the interaction between clinical outcomes and baseline systolic and diastolic BP, and mean arterial pressure (MAP), at 10 mmHg intervals. Data are reported as odds ratios (OR) and 95% CI.

Results: A post-hoc analysis of DIRECT-MT, in 510 of the 656 randomized participants with successful revascularization underwent MT. The overall adjusted common OR of IVT and baseline BP on any ICH, sICH, and 90-day mortality and functional outcome were 0.884 (95%CI 0.613-1.274), 0.643 (95%CI 0.283-1.458), 0.842 (95%CI 0.566-1.252), and 1.286 (95%CI 0.772-2.142), respectively. No significant interaction between baseline blood pressure and intravenous thrombolysis with clinical outcome was observed.

Conclusions: In patients with baseline SBP under 185 mmHg, baseline blood pressure does not alter the risk of hemorrhagic transformation and clinicaloutcome in successfully revascularized patients, regardless of intravenous alteplase usage. Future studies are needed to confirm our findings.

Registration: URL: http://www.clinicaltrials.gov, Identifier: NCT03469206.

Keywords: acute ischemic stroke; baseline blood pressure; endovascular thrombectomy; endovascular treatment; intravenous thrombolysis.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor DC declared a shared affiliation with the authors LS and CA at the time of review.

Copyright © 2022 Xiaoxi, Xuan, Lei, Zifu, Pengfei, Hongjian, Yongxin, Weilong, Yihan, Dongwei, Qiang, Rui, Qinghai, Yi, Song, Anderson, Jianmin, Yongwei and Pengfei.

Figures

Figure 1
Figure 1
Interaction between baseline blood pressure with intravenous alteplase on clinical outcome.

References

    1. Vidale S, Romoli M, Clemente Agostoni E. Mechanical thrombectomy with or without thrombolysis: a meta-analysis of rcts. Acta Neurol Scand. (2021) 143:554–7. 10.1111/ane.13390
    1. Cheng H, Xu C, Jin X, Chen Y, Zheng X, Shi F, et al. . Association of blood pressure at successful recanalization and parenchymal hemorrhage after mechanical thrombectomy with general anesthesia. Front Neurol. (2020) 11:582639. 10.3389/fneur.2020.582639
    1. Du M, Li S, Huang X, Zhang S, Bai Y, Yan B, et al. . Intravenous thrombolysis before thrombectomy may increase the incidence of intracranial hemorrhage intreating carotid t occlusion. J Stroke Cerebrovasc Dis. (2021) 30:105473. 10.1016/j.jstrokecerebrovasdis.2020.105473
    1. Wu X, Ge Y, Chen S, Yan Z, Wang Z, Zhang W, et al. . Thrombectomy with or without thrombolysis in patients with acute ischemic stroke: a systematic review and meta-analysis. J Neurol. (2022) 269:1809–16. 10.1007/s00415-021-10798-x
    1. Mulder M, Ergezen S, Lingsma HF, Berkhemer OA, Fransen PSS, Beumer D, et al. . Baseline blood pressure effect on the benefit and safety of intra-arterial treatment in mr clean (multicenter randomized clinical trial of endovascular treatment of acute ischemic stroke in the netherlands). Stroke. (2017) 48:1869–76. 10.1161/STROKEAHA.116.016225
    1. Ahmed N, Wahlgren N, Brainin M, Castillo J, Ford GA, Kaste M, et al. . Relationship of blood pressure, antihypertensive therapy, and outcome in ischemic stroke treated with intravenous thrombolysis: Retrospective analysis from safe implementation of thrombolysis in stroke-international stroke thrombolysis register (sits-istr). Stroke. (2009) 40:2442–9. 10.1161/STROKEAHA.109.548602
    1. Maïer B, Gory B, Taylor G, Labreuche J, Blanc R, Obadia M, et al. . Mortality and disability according to baseline blood pressure in acute ischemic stroke patients treated by thrombectomy: a collaborative pooled analysis. J Am Heart Assoc. (2017) 6:e006484. 10.1161/JAHA.117.004193
    1. Verschoof MA, Groot AE, Vermeij JD, Westendorp WF, van den Berg SA, Nederkoorn PJ, et al. . Association between low blood pressure and clinical outcomes in patients with acute ischemic stroke. Stroke. (2020) 51:338–41. 10.1161/STROKEAHA.119.027336
    1. Mazighi M, Richard S, Lapergue B, Sibon I, Gory B, Berge J, et al. . Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (bp-target): a multicentre, open-label, randomised controlled trial. Lancet Neurol. (2021) 20:265–74. 10.1016/S1474-4422(20)30483-X
    1. Yang P, Zhang Y, Zhang L, Zhang Y, Treurniet KM, Chen W. et al. Endovascular thrombectomy with or without intravenous alteplase in acute stroke. (2020) 382:1981–93.
    1. Martins AI, Sargento-Freitas J, Silva F, Jesus-Ribeiro J, Correia I, Gomes JP, et al. . Recanalization modulates association between blood pressure and functional outcome in acute ischemic stroke. Stroke. (2016) 47:1571–6. 10.1161/STROKEAHA.115.012544
    1. Teng RSY, Tan BYQ, Miny S, Syn NL, Ho AFW, Ngiam NJH, et al. . Effect of pretreatment blood pressure on outcomes in thrombolysed acute ischemic stroke patients: a systematic review and meta-analysis. J Stroke Cerebrovasc Dis. (2019) 28:906–19. 10.1016/j.jstrokecerebrovasdis.2018.12.008
    1. Tikhonoff V, Zhang H, Richart T, Staessen JA. Blood pressure as a prognostic factor after acute stroke. Lancet Neurol. (2009) 8:938–48. 10.1016/S1474-4422(09)70184-X
    1. Kim BJ, Cho YJ, Hong KS, Lee J, Kim JT, Choi KH, et al. . Trajectory groups of 24-hour systolic blood pressure after acute ischemic stroke and recurrent vascular events. Stroke. (2018) 49:1836–42. 10.1161/STROKEAHA.118.021117
    1. Mistry EA, Mayer SA, Khatri P. Blood pressure management after mechanical thrombectomy for acute ischemic stroke: a survey of the strokenet sites. J Stroke Cerebrovasc Dis. (2018) 27:2474–8. 10.1016/j.jstrokecerebrovasdis.2018.05.003
    1. Anderson CS, Huang Y, Lindley RI, Chen X, Arima H, Chen G, et al. . Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (enchanted): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet (London, England). (2019) 393:877–88. 10.1016/S0140-6736(19)30038-8
    1. Lee M, Ovbiagele B, Hong KS, Wu YL, Lee JE, Rao NM, et al. . Effect of blood pressure lowering in early ischemic stroke: meta-analysis. Stroke. (2015) 46:1883–9. 10.1161/STROKEAHA.115.009552
    1. Forlivesi S, Micheletti N, Tomelleri G, Bovi P, Cappellari M. Association of hyperglycemia, systolic and diastolic hypertension, and hyperthermia relative to baseline in the acute phase of stroke with poor outcome after intravenous thrombolysis. Blood Coagul Fibrinolysis. (2018) 29:167–71. 10.1097/MBC.0000000000000689
    1. Rusanen H, Saarinen JT, Sillanpää N. The association of blood pressure and collateral circulation in hyperacute ischemic stroke patients treated with intravenous thrombolysis. Cerebrovasc Dis. (2015) 39:130–7. 10.1159/000371339
    1. Yong M, Diener HC, Kaste M, Mau J. Long-term outcome as function of blood pressure in acute ischemic stroke and effects of thrombolysis. Cerebrovasc Dis. (2007) 24:349–54. 10.1159/000106981

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever