Blood pressure in the first 6 hours following endovascular treatment for ischemic stroke is associated with outcome

Noor Samuels*, Rob A. van de Graaf, Carlijn A.L. van den Berg, Simone M. Uniken Venema, Kujtesa Bala, Pieter Jan van Doormaal, Wouter van der Steen, Elbert Witvoet, Jelis Boiten, Heleen den Hertog, Wouter J. Schonewille, Jeannette Hofmeijer, Floris Schreuder, Tobien A.H.C.M.L. Schreuder, H. Bart van der Worp, Yvo B.W.E.M. Roos, Charles B.L.M. Majoie, James F. Burke, Adriaan C.G.M. van Es, Aad van der LugtBob Roozenbeek, Hester F. Lingsma, Diederik W.J. Dippel

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

10 Citations (Scopus)
10 Downloads (Pure)


BACKGROUND AND PURPOSE: Optimal blood pressure (BP) management in the acute phase of ischemic stroke remains an unresolved issue. It is uncertain whether guidelines for BP management during and after intravenous alteplase can be extrapolated to endovascular treatment (EVT) for stroke due to large artery occlusion in the anterior circulation. We evaluated the associations between systolic BP (SBP) in the first 6 hours following EVT and functional outcome as well as symptomatic intracranial hemorrhage. METHODS: Patients of 8 MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry centers, with available data on SBP in the 6 hours following EVT, were analyzed. We evaluated maximum, minimum, and mean SBP. Study outcomes were functional outcome (modified Rankin Scale) at 90 days and symptomatic intracranial hemorrhage. We used multivariable ordinal and binary regression analysis to adjust for important prognostic factors and studied possible effect modification by successful reperfusion. RESULTS: Post-EVT SBP data were available for 1161/1796 patients. Higher maximum SBP (per 10 mmHg increments) was associated with worse functional outcome (adjusted common odds ratio, 0.93 [95% CI, 0.88–0.98]) and a higher rate of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.17 [95% CI, 1.02–1.36]). The association between minimum SBP and functional outcome was nonlinear with an inflection point at 124 mmHg. Minimum SBP lower and higher than the inflection point were associated with worse functional outcomes (adjusted common odds ratio, 0.85 per 10 mmHg decrements [95% CI, 0.76–0.95] and adjusted common odds ratio, 0.81 per 10 mmHg increments [95% CI, 0.71–0.92]). No association between mean SBP and functional outcome was observed. Successful reperfusion did not modify the relation of SBP with any of the outcomes. CONCLUSIONS: Maximum SBP in the first 6 hours following EVT is positively associated with worse functional outcome and an increased risk of symptomatic intracranial hemorrhage. Both lower and higher minimum SBP are associated with worse outcomes. A randomized trial to evaluate whether modifying post-intervention SBP results in better outcomes after EVT for ischemic stroke seems justified.

Original languageEnglish
Pages (from-to)3514-3522
Number of pages9
Issue number11
Publication statusPublished - Nov 2021
Externally publishedYes


  • Blood pressure
  • Cerebral hemorrhage
  • Guideline
  • Ischemic stroke
  • Reperfusion

Cite this