Blood pressure (BP) management at the initial stage of stroke caused by large-vessel occlusion (LVO) remains challenging. We assessed the association between baseline BP and clinical and safety outcomes of endovascular treatment (EVT) in different stroke etiologies. Patients with acute ischemic stroke and anterior circulation LVO were screened from a prospective, multicenter registry of EVT from November 2017 to March 2019. The primary outcome was poor 90-day outcome (modified Rankin Scale score 3–6). The safety outcome was 24 h post-procedure parenchymal hematoma (PH). The Trial of Org 101072 in Acute Stroke Treatment criteria were used for etiologic stroke classification. Restricted cubic spline and binary logistic regression analysis were performed to examine the association between study outcomes and natural log-transformed BP. In subgroup analyses, a U-shaped correlation existed between baseline mean arterial pressure (MAP) and poor outcome in large-artery atherosclerosis stroke only. Higher MAP was an independent risk factor compared with a central reference value (≥ 133 mm Hg vs 96–115 mm Hg; adjusted OR [aOR], 2.50; 95 % CI, 1.09 to 5.71, = 0.030). Whereas elevated MAP was associated with PH (aOR, 1.58; 95 % CI 1.04 to 2.39, = 0.030 for a ln10-unit increase in natural log-transformed MAP) in the range <110 mm Hg exclusively for cardioembolic stroke. Whether it is cause or epiphenomenon, baseline BP was associated with 90-day outcome in large-artery atherosclerosis stroke, whereas in cardioembolic stroke baseline BP was correlated with post-procedure PH within a certain range. Identifying these features based on etiological subtypes may offer a reference for BP management in acute LVO stroke.

中文翻译：

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基线血压与大血管闭塞性中风病因亚型结果的关联：来自 ANGEL-ACT 登记处的数据


大血管闭塞（LVO）引起的中风初始阶段的血压（BP）管理仍然具有挑战性。我们评估了不同卒中病因中基线血压与血管内治疗（EVT）的临床和安全性结果之间的关联。 2017 年 11 月至 2019 年 3 月，通过前瞻性、多中心 EVT 登记筛选患有急性缺血性卒中和前循环 LVO 的患者。主要结局是 90 天结局不佳（改良 Rankin 量表评分 3-6）。安全性结果是术后 24 小时实质血肿 (PH)。 Org 101072 急性中风治疗标准试验用于中风病因分类。进行限制三次样条和二元逻辑回归分析来检查研究结果和自然对数转换血压之间的关联。在亚组分析中，仅在大动脉粥样硬化性卒中的基线平均动脉压（MAP）与不良预后之间存在 U 形相关性。与中心参考值相比，较高的 MAP 是一个独立的危险因素（≥ 133 mm Hg vs 96–115 mm Hg；调整后 OR [aOR]，2.50；95% CI，1.09 至 5.71，= 0.030）。而升高的 MAP 与 <110 mm Hg 范围内的 PH 相关（aOR，1.58；95% CI 1.04 至 2.39，= 0.030，自然对数转换 MAP 增加 ln10 单位），范围为 <110 mm Hg，专门针对心源性卒中。无论是原因还是附带现象，大动脉粥样硬化性卒中的基线血压与 90 天的结果相关，而心源性卒中的基线血压在一定范围内与术后 PH 值相关。根据病因亚型识别这些特征可能为急性 LVO 脑卒中的血压管理提供参考。