Pulse pressure: effective predictor for clinical outcomes after thrombectomy
Authors: Li Jianru , Jiang Shandong , Guo Peizheng , yuan Yuan , Yu Jun , Xu Liang , Li Xu , Chen Xianyi , Fang Bing , Tan Zhongju , Xu Jing , Qian Cong 
Published: November 2024

Background

Previous guidelines for post-operative blood pressure (BP) management have focused on SBP and DBP in stroke patients who have undergone intravenous thrombolysis (IVT). Whether pulse pressure (PP) affects the prognosis of patients with ischemic stroke after endovascular thrombectomy (EVT) remains an unresolved issue.

Methods

In this study, we systematically collected twelve BP parameters within 24 hours after thrombectomy and regularly followed up to assess the mRS scores. We utilized univariate and multivariate logistic regression analyses to identify predictive factors for poor prognosis and morality following EVT. Restrictive cubic splines (RCS) are used to evaluate the dose-effect relationship between PP and outcome events. Subgroup analyses were conducted to assess the prognostic efficacy of mean PP across different patient groups, with a favorable outcome defined as a modified Rankin Scale (mRS) score between 0 and 3 at three months post-EVT.

Results

Post-EVT SBP data were available for 587/826 patients. Mean PP demonstrates a significant positive dose-response relationship with the occurrence of functional outcomes, sICH, and mortality after EVT. The predictive power and strength of association of mean PP with prognosis are superior to those of single SBP or DBP alone with the strongest ORs and highest diagnostic performance. Mean PP exhibits a linear relationship with all other outcome events, except for mortality at 12 months post-EVT.

Conclusion

The mean PP within 24 hours after EVT is an independent risk factor for sICH, prognosis, and mortality in stroke patients, with a stronger association and diagnostic performance than either SBP or DBP. Achieving consistent long-term control of SBP and PP may be beneficial for improving the prognosis of ischemic stroke patients.

What is already known on this topic

It has been confirmed that the post-procedure blood pressure (BP) are closely related to the onset and progression of stroke. Previous guidelines for postoperative blood pressure (BP) management have focused on SBP and DBP in stroke patients who have undergone intravenous thrombolysis (IVT). Whether pulse pressure (PP) affects the prognosis of patients with ischemic stroke after endovascular thrombectomy (EVT) remains an unresolved issue.

What this study adds

Mean PP demonstrates a significant positive dose-response relationship with the occurrence of functional outcomes, sICH, and mortality after thrombectomy. The predictive power and strength of association of mean PP with prognosis are superior to those of single SBP or DBP alone with the strongest ORs and highest diagnostic performance (AUC=0.661, 95% CI 0.617 to 0.705).

How this study might affect research, practice or policy

In Clinical, we usually focus on controlling post-procedure SBP or DBP after EVT. In this study, we demonstrated that the mean PP within 24 hours after EVT is an independent risk factor for sICH, prognosis, and mortality in stroke patients. Achieving consistent long-term control of SBP and PP may be beneficial for improving the prognosis of ischemic stroke patients.