Association of baseline blood pressure and outcomes in etiology subtypes of large vessel occlusion stroke: Data from ANGEL-ACT Registry - 08/08/24

Doi : 10.1016/j.neurad.2024.101213

Haifeng Xu ¹, Dapeng Sun ¹, Ligang Song ¹, Dapeng Mo ¹, Ning Ma ¹, Anxin Wang ^2,³, Feng Gao ¹, Xuelei Zhang ¹, Baixue Jia ^1,^⁎ , Zhongrong Miao ^1,^⁎
on behalf of the
ANGEL-ACT study group
¹ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
² Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
³ China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

^⁎Correspondence to: Zhongrong Miao & Baixue Jia, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South 4th Ring West Road, Fengtai District, Beijing, China, 100070., Tel: +86-136 0124 3293Department of Interventional NeuroradiologyBeijing Tiantan HospitalCapital Medical UniversityNo.119 South 4th Ring West RoadBeijing100070China

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Thursday 08 August 2024

Highlights

•	The management of blood pressure early after acute stroke caused by large vessel occlusion is complex, with limited evidence of effectiveness.
•	In the subgroup analysis based on the etiology of large vessel occlusion stroke, the association between baseline blood pressure and poor outcome was specific to large-artery atherosclerosis subtype.
•	The correlation between baseline blood pressure and post-procedure parenchymal hematoma was unique to cardioembolism subtype.
•	Stroke etiology is an important consideration that warrants for exploration in blood pressure management during the acute phase of large vessel occlusion stroke.

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ABSTRACT

Background

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.

Methods

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 24h 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.

Results

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, P=0.030). Whereas elevated MAP was associated with PH (aOR, 1.58; 95% CI 1.04 to 2.39, P=0.030 for a ln10-unit increase in natural log-transformed MAP) in the range less than 110 mm Hg exclusively for cardioembolic stroke.

Conclusion

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.

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Graphical abstract

Image, graphical abstract

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Keywords : Blood Pressure, Stroke, Hemorrhage, Thrombectomy

Plan

BP collection and management

Statistical analysis

Results

Baseline BP and outcomes in the entire population

Subgroup analysis according to stroke etiology

Discussion

Limitations

Conclusion

Patient consent for publication

Data availability statement

Funding

	Disclaimers: The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of the authors' organizations.
	Disclosure of relationships and activities: All authors have completed the ICMJE uniform disclosure form at disclosure-of-interest/ and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
	Registration: https://www.clinicaltrials.gov Identifier: NCT03370939.
	Collaborators: ANGEL-ACT study group: Liqiang Gui (Langfang Changzheng Hospital, Hebei, China); Cunfeng Song (Liaocheng Third People's Hospital, Shandong, China); Ya Peng (The First People's Hospital of Changzhou, Jiangsu, China); Jin Wu (Second Affiliated Hospital of Nanjing Medical University, Jiangsu, China); Shijun Zhao (Fengrun District People's Hospital of Tangshan City, Hebei, China); Junfeng Zhao (SiPing Central People's Hospital, Jilin, China); Zhiming Zhou (Yijishan Hospital of Wannan Medical College, Anhui, China); Yongli Li (The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China); Ping Jing (Central Hospital of Wuhan, Hubei, China); Lei Yang (First Hospital of Shijiazhuang, Hebei, China); Yajie Liu (Shenzhen Hospital of Southern Medical University, Guangdong, China); Qingshi Zhao (Longhua People's Hospital, Guangdong, China); Yan Liu (Jingjiang People's Hospital, Jiangsu, China); Xiaoxiang Peng (The Third People's Hospital of Hubei Province, Hubei, China); Qingchun Gao (Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China); Zaiyu Guo (Tianjin TEDA Hospital, Tianjin, China); Wenhuo Chen (Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China); Weirong Li (Taiyuan Central Hospital, Shanxi, China); Xiaojiang Cheng (First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China); Yun Xu (Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China); Yongqiang Zhang (Wenling First People's Hospital, Zhejiang, China); Guilian Zhang (The Second Affiliated Hospital of Xi'an Jiaotong University, Shaanxi, China); Yijiu Lu (Yulin First People's Hospital, Guangxi, China); Xinyu Lu (Zhenjiang First People's Hospital, Jiangsu, China); Dengxiang Wang (Qitaihe Coal General Hospital Heilongjiang, China); Yan Wang (People's Hospital of Tangshan City, Hebei, China); Hao Li (Affiliated Hospital of Guilin Medical University, Guangxi, China); Yang Hua (The Affiliated Hospital of Guizhou Medical University, Guizhou Province, China); Deqin Geng (The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China); Haicheng Yuan (Qingdao Central Hospital, Shandong, China); Hongwei Wang (The Fourth People's Hospital of Langfang City, Hebei, China); Haihua Yang (Beijing Daxing Hospital, Beijing, China); Zengwu Wang (Weifang People's Hospital, Shandong, China); Liping Wei (Luoyang General Hospital Affiliated to Zhengzhou University, Henan, China); Xuancong Liufu (Dongguan Kanghua Hospital, Guangdong, China); Xiangqun Shi (Shunde Hospital of Southern Medical University, Guangdong, China); Juntao Li (Handan Central Hospital, Hebei, China); Wenwu Yang (The 981 Hospital of the Chinese People's Liberation Army, Hebei, China); Wenji Jing (Linfen People's Hospital, Shanxi, China); Xiang Yong (Anshun People's Hospital of Guizhou, China); Leyuan Wang (Changle People's Hospital, Shandong, China); Chunlei Li (The Second People's Hospital of Dongying, Shandong, China); Yibin Cao (Tangshan Gongren Hospital, Hebei, China); Qingfeng Zhu (PLA 985 Hospital of the Joint Logistics Support Force, Shanxi, China); Peng Zhang (Gaomi People's Hospital, Shandong, China); Xiang Luo (Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China); Shengli Chen (Chongqing Sanxia Center Hospital, Chongqing, China); WenWu Peng (Hospital of Traditional Chinese Medicine of Qiannan, Guizhou, China); Lixin Wang (Guangdong Hospital of Chinese Medicine, Guangdong, China); Xue Wen (People's Hospital of Yangjiang, Guangdong, China); Shugui Shi (The Third Affiliated Hospital of CQMU, Chongqing, China); Wanming Wang (General Hospital of The Yangtze River Shipping, Hubei, China); Wang Bo (First People's Hospital of Bijie City, Guizhou, China); Pu Yuan (Suqian People's Hospital of Nanjing Drum-Tower Hospital Group, Jiangsu, China); Dong Wang (Weifang TCM Hospital, Shandong, China); Haitao Guan (Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China); Wenbao Liang (Karamay Central Hospital, Xinjiang, China); Daliang Ma (Third People's Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China); Long Chen (Wulanchabu City Central Hospital, Inner Mongolia, China); Yan Xiao (Hospital of Xinjiang Production and Construction Corps, Xinjiang, China); Xiangdong Xie (Jiaozuo Second People's Hospital, Henan, China); Zhonghua Shi (The 904 Hospital of Joint Logistic Support Force of PLA, Jiangsu, China); Xiangjun Zeng (Ganzhou People's Hospital, Jiangxi, China); Fanfan Su (The 967 Hospital of the Joint Logistics Support Force of PLA, Liaoning, China); Mingze Chang (The Affiliated Hospital of Northwest University Xi'an No 3 Hospital, Shaanxi, China); Jijun Yin (The Second Hospital of Liao Cheng, Shandong, China); Hongxia Sun (Jilin Province People's Hospital, Jilin, China); Chong Li (People's Hospital of Huanghua City, Hebei, China); Yong Bi (Shanghai Forth People's Hospital, Shanghai, China); Gang Xie (Wanbei Coal-Electricity Group General Hospital, Anhui, China); Yuwu Zhao (Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China); Chao Wang (Binzhou Medical University Hospital, Shandong, China); Peng Zhang (The 988 Hospital of the People's Liberation Army, Henan, China); XianjunWang (Linyi People's Hospital, Shandong, China); Dongqun Li (Yingkou City Central Hospital, Liaoning, China); Hui Liang (Yantaishan Hospital, Shandong, China); Zhonglun Chen (Mianyang Central Hospital, Sichuan, China); Yan Wang (Chengdu Fifth People's Hospital, Sichuan, China); Yuxin Wang (Hengshui Fifth Hospital of Heng Shui City, Hebei, China); Lin Yin (Second Hospital of Dalian Medical University, Liaoning, China); HongKai Qiu (Boai Hospital of Zhongshan, Guangdong, China); Jun Wei (The First People's Hospital of Yibin, Sichuan, China); Yaxuan Sun (Shanxi Provincial People's Hospital, Shanxi, China); Xiaoya Feng (Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China); Weihua Wu (Chuxiong State People's Hospital, Chuxiong, Yunnan, China); Lianbo Gao (The Fourth Affiliated Hospital of China Medical University, Liaoning, China); Zhibing Ai (Taihe Hospital, Shiyan, Hubei, China); Lan Tan (Qingdao Municipal Hospital, Shandong, China); Li Ding (First People's Hospital of Yunnan Province, Yunnan, China); Qilong Liang (Lanzhou NO.2 People's Hospital, Gansu, China); Zhimin Wang (Taizhou First People's Hospital, Zhejiang, China); Jianwen Yang (Hunan Provincial People's Hospital, Hunan, China); Ping Xu (First People's Hospital of Changde City, Hunan, China); Wei Dong (Zhejiang Yuyao People's Hospital, Zhejiang, China); Quanle Zheng (Aidebao Hospital, Hebei, China); Zhenyun Zhu (The First Hospital of Fangshan District, Beijing, China); Liyue Zhao (Tianjin Xiqing Hospital, Tianjin, China); Qingbo Meng (People's Hospital of Zunhua, Hebei, China); Yuqing Wei (Xingtai Third Hospital, Hebei, China); Xianglin Chen (Qingyuan People's Hospital, Guangdong, China); Wei Wang (Fengcheng City Central Hospital, Liaoning, China); Dong Sun (People's Hospital of Hejian City, Hebei, China); Yongxing Yan (Hangzhou Third People's Hospital, Zhejiang, China); Guangxiong Yuan (Xiangtan Central Hospital, Hunan, China); Yadong Yang (People's Hospital of Nanpi Country, Hebei, China); Jianfeng Zhou (Liuzhou Railway Central Hospital, Guangxi, China); Zhi Yang (Maoming People's Hospital, Guangdong, China); Zhenzhong Zhang (Tongde Hospital of Zhejiang Province, Zhejiang, China); Ning Guan (The First Affiliated Hospital of Jinzhou Medical University, Liaoning, China); Huihong Wang (Xishan Coal Electricity Group Worker General Hospital, Shaanxi, China).
	Contributors: ZM and BJ planned the project. AW performed statistical analysis. DS and LS contributed to data interpretation. HX drafted the manuscript. DM, NM, FG and XZ provided comments on the manuscript. ZM and BJ are the guarantors of this work.
	Ethics approval: The study protocol received ethical approval from our institutional review board and informed consent was obtained. The ID of the approval: KY2017-048-01. Participants gave informed consent to participate in the study.