Niels Juul

The influence of blood pressure management on neurological outcome in endovascular therapy for acute ischaemic stroke

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperJournal articleResearchpeer-review

  • M. Rasmussen
  • U. S. Espelund, Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Aarhus, Denmark., Aarhus University Hospital
  • ,
  • N. Juul
  • A. J. Yoo, Texas Stroke Institute
  • ,
  • L. H. Sørensen, Aarhus University Hospital
  • ,
  • K. E. Sørensen, Aarhus University Hospital
  • ,
  • S. P. Johnsen, Aarhus University Hospital
  • ,
  • G. Andersen, Aarhus University Hospital
  • ,
  • C. Z. Simonsen

Background: Observational studies have suggested that low blood pressure and blood pressure variability may partially explain adverse neurological outcome after endovascular therapy with general anaesthesia (GA) for acute ischaemic stroke. The aim of this study was to further examine whether blood pressure related parameters during endovascular therapy are associated with neurological outcome. Methods: The GOLIATH trial randomised 128 patients to either GA or conscious sedation for endovascular therapy in acute ischaemic stroke. The primary outcome was 90 day modified Rankin Score. The haemodynamic protocol aimed at keeping the systolic blood pressure >140 mm Hg and mean blood pressure >70 mm Hg during the procedure. Blood pressure related parameters of interest included 20% reduction in mean blood pressure; mean blood pressure <70 mm Hg, <80 mm Hg, and <90 mm Hg, respectively; time with systolic blood pressure <140 mm Hg; procedural minimum and maximum mean and systolic blood pressure; mean blood pressure at the time of groin puncture; postreperfusion mean blood pressure; blood pressure variability; and use of vasopressors. Sensitivity analyses were performed in the subgroup of reperfused patients. Results: Procedural average mean and systolic blood pressures were higher in the conscious sedation group (P<0.001). The number of patients with mean blood pressure <70–90 mm Hg and systolic blood pressure <140 mm Hg, blood pressure variability, and use of vasopressors were all higher in the GA group (P<0.001). There was no statistically significant association between any of the examined blood pressure related parameters and the modified Rankin Score in the overall patient population, and in the subgroup of patients with full reperfusion. Conclusion: We found no statistically significant association between blood pressure related parameters during endovascular therapy and neurological outcome. Clinical trial registration: NCT 02317237.

Original languageEnglish
JournalBritish Journal of Anaesthesia
Volume120
Issue6
Pages (from-to)1287-1294
Number of pages8
ISSN0007-0912
DOIs
Publication statusPublished - 1 Jun 2018

    Research areas

  • anaesthesia, blood pressure, conscious sedation, reperfusion, stroke

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