Abstract TP149: Association Of 24-hour Blood Pressure Parameters Post-thrombectomy With Functional Outcomes According To Collateral Status

Introduction: Higher blood pressure (BP) most post mechanical thrombectomy (MT) can influence perfusion in the ischemic brain tissue depending on collateral status. We aim to determine the association of 24 hour post MT BP parameters with the functional outcome depending on the pre MT collateral status. Methods: We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. The patients were divided into two groups (good versus bad) depending on collateral status. A board certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading scales of Mass ≥3 and modified-Tan>50% to designate good collaterals on the pre MT CT Angiogram. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, time to thrombectomy, LDL, Hemoglobin A1C, intravenous alteplase, with the 24 hour post MT BP parameters as the predictors. The outcomes were good functional outcome (90 day mRS≤2) and mortality. Results: 220 patients met the inclusion criteria. Lower 24 hour BP parameters of standard deviation (SD) SBP (OR,1.16; 95% CI,1.01-1.33; P 0.047) and maximum DBP (OR,1.05; 95% CI,1.01-1.09; P 0.036) were associated with good functional outcome, while higher values of SD SBP (OR,1.15; 95% CI,1.01-1.31; P 0.045), coefficient variation (CV) SBP (OR,1.19; 95% CI,1.01-1.41; P 0.043), SBP range (OR,1.04; 95% CI,1.01-1.07; P 0.046), maximum DBP (OR,0.95; 95% CI,0.91-0.99; P 0.016), pulse pressure (OR,1.09; 95% CI,1.02-1.16; P 0.022) and SBP≥140 (OR,5.85; 95% CI,1.11-30.85; P 0.038) were associated with mortality in patients with good collaterals according to Mass grading. Higher values of BP parameters of SD SBP (OR,1.13; 95% CI,1.04-1.24; P 0.007), CV SBP (OR,1.18; 95% CI,1.05-1.32; P 0.006), SBP range (OR,1.04; 95% CI,1.01-1.06; P 0.008) and maximum DBP (OR,0.97; 95% CI,0.94-1; P 0.02) were associated with mortality in patients with good collaterals according to modified-Tan grading. There was no such association in patients with bad collaterals. Conclusion: Various higher 24 hour BP parameters post MT are associated with a bad functional outcome or mortality in patients with good collaterals, unlike in patients with bad collaterals.