Abstract Number ‐ 27: VARIANCE: Variability of Assessed BP Readings In Acute Neuro‐intervention Cases and its Effect on outcomes
Authors: Van Orden Kimberlee , Staniszewski Thomas , Torres Dolores , Poynor Briana , Alwood Benjamin , Agrawal Kunal , Meyer Brett , Meyer Dawn 
Published: April 2023

Introduction

Blood pressure variability (BPV) following endovascular thrombectomy (EVT) in acute ischemic strokes is associated with poor functional outcomes both in the short and long term. Patient variables which may predict high BPV must be examined to improve outcomes. The purpose of this study is to analyze the affect of BPV on outcomes in patients with good recanalization with EVT and examine potential predictors of BPV.

Methods

We conducted a retrospective analysis of prospectively collected data from an IRB approved Stroke Registry of two academic Comprehensive Stroke Centers in Southern California between 2017 and 2022. Patients were included if they had 1) anterior circulation ischemic stroke due to large vessel occlusions (LVO) and 2) successful EVT with TICI 2b‐3. All BPs were recorded as immediate pre‐op SBP and DBP (one minute prior to procedure start time), immediate post‐op SBP and DBP (at time of recanalization), and 24 hours post revascularization. Variables examined include age, sex, Hispanic ethnicity, initial NIHSS, history of HTN, current antihypertensive use, symptom onset to groin puncture time, door to groin puncture time, and symptomatic ICH (sICH). Outcome was assessed via hospital discharge disposition and modified Rankin Scale at 90 days. Good short‐term outcome was disposition to home or rehab. Good long‐term outcome was mRS of 0–2. BPV was defined by the average real variability (ARV) calculated as the absolute value of the average of the differences between consecutive BP measurements divided by the number of measurements. A correlation matrix was used to identify both continuous and categorical variables with a significant correlation with ARV (p≤0.10). A stepwise logistic regression model for good versus poor outcome was created by including all significant variable from the correlation matrix. A significance level of p≤0.05 was included for all non‐correlational analysis.

Results

We identified 253 patients (mean age 70±14 years, 51.4% female). 49% were white, 6.3% asian, 5.5% black, 1.6% native Hawaiian pacific islander, and 37.5% are unspecified. 30.4% were Hispanic. The median NIHSS was 17±8. Mean BMI was 27±8. Mean symptom onset to groin puncture time was 478±326 mins. Mean door to groin puncture time was 86±110 mins. 34.8% of patients received tPA (100% of those eligible as our population included patients in the extended window who qualified per DAWN/DEFUSE‐3). 57.2% had cardioembolic etiology. 4.7% had sICH. 58.9% of patients had a good discharge disposition. ARVAB as defined as the average SBP variability as an absolute value was 30.6±25.6. ARVAB was associated with sex, home antihypertensive use, and immediate pre‐op and post‐op SBPs. ARVAB was not associated with age, initial NIHSS, Hispanic ethnicity, HTN, rate of sICH, or short or long term outcome.

Conclusions

There was a significant correlation with female sex and home use of antihypertensives and higher BPV. These variables can potentially be used as predictors of BPV. BPV was not correlated with discharge disposition or 90 day mRS in our population. While our study did not show a positive correlation between BPV and outcome, our ARVAB was lower than prior populations likely due to more accurate BP monitoring and control.