Progress on Blood Pressure Management in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy

doi:10.3969/j.issn.1673-5765.2023.09.015

Abstract

Abstract: The level of blood pressure management in acute ischemic stroke is associated with prognosis. Too high or too low blood pressure may lead to poor prognosis. Mechanical thrombectomy is widely used in clinical practice, and its preoperative, intraoperative and postoperative blood pressure management is one of the important interventions affecting clinical prognosis. However, the specific target value of blood pressure management is still inconclusive, especially the postoperative blood pressure management is controversial. Its recanalization status, reperfusion injury, and blood pressure variability all affect its blood pressure management range. Clinically, it is necessary to formulate personalized plans and explore reasonable blood pressure target plans based on the specific conditions of patients.

Key words: Acute ischemic stroke; Mechanical thrombectomy; Blood pressure management; Prognosis

摘要： 急性缺血性卒中血压管理水平与预后相关，过高或过低的血压都可能导致预后不良。机械取栓术广泛应用于临床，其术前、术中与术后的血压管理是影响临床预后的重要干预措施之一，但血压管理的具体目标值尚无定论，尤其是术后的血压管理仍存在争议。再通状态、再灌注损伤、血压变异性都影响机械取栓患者的血压水平，临床上需要结合患者具体情况，制定个体化方案，探索合理血压目标控制方案。

关键词: 急性缺血性卒中; 机械取栓; 血压管理; 预后

ZHOU Yumeng, CHEN Lixia. Progress on Blood Pressure Management in Patients with Acute Ischemic Stroke Undergoing Mechanical Thrombectomy[J]. Chinese Journal of Stroke, 2023, 18(9): 1073-1078.

周雨萌, 陈丽霞. 急性缺血性卒中机械取栓患者的血压管理研究进展[J]. 中国卒中杂志, 2023, 18(9): 1073-1078.

Add to citation manager EndNote|Ris|BibTeX

URL: https://www.chinastroke.org.cn/EN/10.3969/j.issn.1673-5765.2023.09.015

https://www.chinastroke.org.cn/EN/Y2023/V18/I9/1073

References

[1] GĄSECKI D，COCA A，CUNHA P，et al. Blood pressure in acute ischemic stroke：challenges in trial interpretation and clinical management：position of the ESH Working Group on Hypertension and the Brain[J]. J Hypertens，2018，36（6）：1212-1221.
[2] BANGALORE S，SCHWAMM L，SMITH E E，et al. Blood pressure and in-hospital outcomes in patients presenting with ischaemic stroke[J]. Eur Heart J，2017，38（37）：2827-2835.
[3] BÖSEL J. Blood pressure control for acute severe ischemic and hemorrhagic stroke[J]. Curr Opin Crit Care，2017，23（2）：81-86.
[4] GĄSECKI D，KWARCIANY M，KOWALCZYK K，et al. Blood pressure management in acute ischemic stroke[J/OL]. Curr Hypertens Rep，2020，23：1-11[2022-09-02]. https://doi.org/10.1007/s11906-020-01120-7.
[5] JAFARI M，DAMANI R. Blood pressure variability and outcome after acute intracerebral hemorrhage[J/OL]. J Neurol Sci，2020，413：116766[2022-09-02]. https://doi.org/10.1016/j.jns.2020.116766.
[6] MISTRY E A，MISTRY A M，NAKAWAH M O，et al. Systolic blood pressure within 24 hours after thrombectomy for acute ischemic stroke correlates with outcome[J/OL]. J Am Heart Assoc，2017，6（5）：e006167[2022-09-02]. https://doi.org/10.1161/JAHA.117.006167.
[7] GOYAL M，DEMCHUK A M，MENON B K，et al. Randomized assessment of rapid endovascular treatment of ischemic stroke[J]. N Engl J Med，2015，372（11）：1019-1030.
[8] POWERS W J，RABINSTEIN A A，ACKERSON T，et al. Guidelines for the early management of patients with acute ischemic stroke：2019 update to the 2018 guidelines for the early management of acute ischemic stroke：a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J/OL]. Stroke，2019，50（12）：e344-e418[2022-09-02]. https://doi.org/10.1161/STR.0000000000000211.
[9] JOVIN T G，SAVER J L，RIBO M，et al. Diffusion-weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake up and late presenting strokes undergoing neurointervention with Trevo（DAWN）trial methods[J]. Int J Stroke，2017，12（6）：641-652.
[10] GOYAL M，MENON B K，VAN ZWAM W H，et al. Endovascular thrombectomy after large-vessel ischaemic stroke：a meta-analysis of individual patient data from five randomised trials[J]. Lancet，2016，387（10029）：1723-1731.
[11] BLECH B，CHONG B W，SANDS K A，et al. Are postprocedural blood pressure goals associated with clinical outcome after mechanical thrombectomy for acute ischemic stroke?[J]. Neurologist，2019，24（1）：44-47.
[12] BATH P M W，KRISHNAN K. Interventions for deliberately altering blood pressure in acute stroke[J/OL]. Cochrane Database Syst Rev，2014（10）：CD000039[2022-09-02]. https://doi.org/10.1002/14651858.CD000039.pub3.
[13] LEE M，OVBIAGELE B，HONG K S，et al. Effect of blood pressure lowering in early ischemic stroke：meta-analysis[J]. Stroke，2015，46（7）：1883-1889.
[14] MULDER M J H L，ERGEZEN S，LINGSMA H F，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）[J]. Stroke，2017，48（7）：1869-1876.
[15] WAHLGREN N，AHMED N，ERIKSSON N，et al. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials：safe implementation of thrombolysis in stroke-monitoring study（SITS-MOST）[J]. Stroke，2008，39（12）：3316-3322.
[16] MAÏER B，GORY B，TAYLOR G，et al. Mortality and disability according to baseline blood pressure in acute ischemic stroke patients treated by thrombectomy：a collaborative pooled analysis[J/OL]. J Am Heart Assoc，2017，6（10）：e006484[2022-09-02]. https://doi.org/10.1161/JAHA.117.006484.
[17] OLIVEIRA R S S，CIARLARIELLO V B，MARTINS H N F，et al. Blood pressure behavior during mechanical thrombectomy and drugs used for conscious sedation or general anesthesia[J]. Arq Neuropsiquiatr，2021，79（8）：660-665.
[18] TALKE P O，SHARMA D，HEYER E J，et al. Society for neuroscience in anesthesiology and critical care expert consensus statement：anesthetic management of endovascular treatment for acute ischemic stroke*：endorsed by the Society of Neurointerventional Surgery and the Neurocritical Care Society[J]. J Neurosurg Anesthesiol，2014，26（2）：95-108.
[19] YAGI M，WATANABE S，KONDO C，et al. Assessment of factors associated with prominent changes in blood pressure during an early mobilization protocol for patients with acute ischemic stroke after mechanical thrombectomy[J]. Phys Ther Res，2016，19（1）：1-7.
[20] MISTRY E A，MAYER S A，KHATRI P. Blood pressure management after mechanical thrombectomy for acute ischemic stroke：a survey of the strokenet sites[J]. J Stroke Cerebrovasc Dis，2018，27（9）：2474-2478.
[21] JEONG H G，KIM B J，KIM H，et al. Blood pressure drop and penumbral tissue loss in nonrecanalized emergent large vessel occlusion[J]. Stroke，2019，50（10）：2677-2684.
[22] JOHN S，HAZAA W，UCHINO K，et al. Timeline of blood pressure changes after intra-arterial therapy for acute ischemic stroke based on recanalization status[J]. J Neurointerv Surg，2017，9（5）：455-458.
[23] JAFARI M，DESAI A，DAMANI R. Blood pressure management after mechanical thrombectomy in stroke patients[J/OL]. J Neurol Sci，2020，418：117140[2022-09-02]. https://doi.org/10.1016/j.jns.2020.117140.
[24] ANADANI M，ORABI M Y，ALAWIEH A，et al. Blood pressure and outcome after mechanical thrombectomy with successful revascularization[J]. Stroke，2019，50（9）：2448-2454.
[25] MAÏER B，DELVOYE F，LABREUCHE J，et al. Impact of blood pressure after successful endovascular therapy for anterior acute ischemic stroke：a systematic review[J/OL]. Front Neurol，2020，11：573382[2022-09-02]. https://doi.org/10.3389/fneur.2020.573382.
[26] GIGLIOTTI M J，PADMANABAN V，RICHARDSON A，et al. Effect of blood pressure management strategies on outcomes in patients with acute ischemic stroke after successful mechanical thrombectomy[J/OL]. World Neurosurg，2021，148：e635-e642[2022-09-02]. https://doi.org/10.1016/j.wneu.2021.01.052.
[27] MAZIGHI M，RICHARD S，LAPERGUE B，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[J]. Lancet Neurol，2021，20（4）：265-274.
[28] SHI Z，LI E S，ZHONG J S，et al. Predictive significance of day-to-day blood pressure variability in acute ischemic stroke for 12-month functional outcomes[J]. Am J Hypertens，2017，30（5）：524-531.
[29] ENDO K，KARIO K，KOGA M，et al. Impact of early blood pressure variability on stroke outcomes after thrombolysis：the SAMURAI rt-PA registry[J]. Stroke，2013，44（3）：816-818.
[30] SKALIDI S J，MANIOS E D，STAMATELOPOULOS K S，et al. Brain edema formation is associated with the time rate of blood pressure variation in acute stroke patients[J]. Blood Press Monit，2013，18（4）：203-207.
[31] MANNING L S，ROTHWELL P M，POTTER J F，et al. Prognostic significance of short-term blood pressure variability in acute stroke：systematic review[J]. Stroke，2015，46（9）：2482-2490.
[32] NEPAL G，SHRESTHA G S，SHING Y K，et al. Systolic blood pressure variability following endovascular thrombectomy and clinical outcome in acute ischemic stroke：a meta-analysis[J]. Acta Neurol Scand，2021，144（4）：343-354.
[33] CHANG J Y，JEON S B，JUNG C，et al. Postreperfusion blood pressure variability after endovascular thrombectomy affects outcomes in acute ischemic stroke patients with poor collateral circulation[J/OL]. Front Neurol，2019，10：346[2022-09-02]. https://doi.org/10.3389/fneur.2019.00346.