VARIANCE: Variability of Assessed BP Readings In Acute Neuro-intervention Cases and its Effect on outcomes

BackgroundBlood pressure variability (BPV) following endovascular thrombectomy (EVT) in AIS has been associated with poor outcome. Variables that predict high BPV must be examined to improve outcome. The purpose of this study is to analyze predictors and effect of BPV on outcome in patients with good recanalization after EVT. MethodsWe conducted a retrospective analysis of prospectively collected data from an IRB approved registry of two academic Comprehensive Stroke Centers between 2017-2022. Patients were included if they had 1) anterior circulation large vessel occlusions (LVO) and 2) EVT with TICI 2b-3. All BPs were recorded as immediate pre-op SBP/DBP (one minute prior to procedure), immediate post-op SBP/DBP (at time of recanalization), and 24 hours post revascularization. Demographic variables, stroke time metrics, and symptomatic ICH (sICH) were assessed. Outcome included discharge disposition and 90 day modified Rankin Scale. Good short-term outcome was disposition to home/acute rehabilitation and good long-term outcome was mRS 0-2. BPV was the average of the differences between measurements divided by the number of measurements. R ResultsWe identified 253 patients (mean age 70{+/-}14, 51.4% female, 49% white, 30.4% Hispanic). Median NIHSS was 17{+/-}8 and mean onset to groin puncture was 478{+/-}326 mins. Mean door to groin puncture was 86{+/-}110 mins. Good discharge occurred in 58.9% of patients. Mean BPV was 30.6{+/-}25.6mmHg and was significantly correlated with female sex, home antihypertensive use, and immediate pre and post-op SBP. BPV was not associated with age, initial NIHSS, Hispanic ethnicity, HTN, sICH, discharge disposition or 90 day mRS. ConclusionThere was a significant correlation of high BPV with female sex and home antihypertensives use. BPV was not correlated with short or long term outcome in this population, however, BPV was lower than prior populations. Assessment of BPV in various stroke centers and populations is necessary to understand the effect of BPV on stroke outcome.