Blood pressure reduction after LVO potential target for intervention

In patients with large vessel occlusion (LVO), marked and frequently iatrogenic blood pressure reductions occur around the time of initial imaging and prior to endovascular therapy (EVT), and may present a potential target for therapeutic intervention.

Decrease in blood pressure before reperfusion may increase the risk of infarct progression and poor functional outcome. A new study looked at the relation of blood pressure reductions during the hyperacute period of stroke with infarct progression and functional outcome [1]. Patients with LVO undergoing EVT were prospectively enrolled. To study timing of blood pressure reductions, high-frequency blood pressure and haemodynamic monitoring were used. Outcomes were analysed of 45 patients who underwent continuous blood pressure monitoring. Mean age was 72 years, 26 (58%) were female, mean NIH Stroke Scale score was 13.

There was a marked blood pressure reduction around the time of imaging, from which patients recovered, as well as a sustained decrease in blood pressure after groin puncture, without return to baseline. After adjusting for age and admission NIH Stroke Scale score, mean arterial pressure difference from baseline (ΔMAP) was independently associated with infarct growth (P=0.02). On average, there was a 16 mL increase in infarct volume for every 10 mmHg reduction in ΔMAP (P=0.054) in the hyperacute phase before reperfusion. The authors suggested that the observed changes in haemodynamic variables throughout the acute stroke period indicate that fluid resuscitation could be used for haemodynamic optimisation.

1. Peshwe KU, et al. Blood Pressure Reductions in the Hyperacute Phase of Large Vessel Occlusion Ischemic Stroke Are Associated With Infarct Progression And Poor Functional Outcome. S6.003, AAN 2021 Virtual Congress, 17-22 April.

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