Abstract WP157: Prognostic Impact Of Pulse Pressure At Admission On Functional Outcomes Post-thrombectomy For Acute Ischemic Stroke

Introduction: Prior studies showed that pulse pressure (PP) correlates with cerebral collateral status, but the prognostic impact of widened PP on thrombectomy outcomes following acute ischemic stroke (AIS) is unclear. We hypothesized that patients with AIS undergoing thrombectomy with a presenting PP of > 60 on admission would be less likely to have successful revascularization and have worse functional outcomes. Methods: Patients treated with a thrombectomy from our institutional retrospective stroke database between 2018 to 2022 were included. Patient demographics and post-thrombectomy outcomes were analyzed using nonparametric t-tests and Chi-Square analysis, with variables <0.20 p-value being included in regression analysis. Results: Of the 134 AIS patients, 60% had a PP > 60. Patients with PP > 60 were older [age 77 (interquartile range (IQR) 68-87) vs 67 (IQR (57-78), p< 0.0001]. There was no difference in the distribution of sex [male 53% vs 52%, p=0.94], M1 occlusion [56% vs 58%, p=0.78], time from last known well to arterial access [306 min (IQR 155-764) vs 242 min (IQR 155-583), p=0.61], NIHSS [17 (IQR 10-23) vs 18 (IQR 11-22), p=0.90], thrombolysis [40% vs 40%, p=0.97], in patients with PP > 60 vs those with a PP ≤ 60 respectively. Discharge mRS was 4 (IQR 4-5) in patients with PP > 60 vs 4 (IQR 4-4) in patients with PP ≤ 60, p=0.02. In this study, 40% lacked a discharge mRS, and no significance was found on 90-day mRS [PP > 60 4 (IQR 2-5) vs 3 (IQR 3-4) PP ≤ 60]. A trend of more patients with PP ≤ 60 having TICI2B/TICI3 was found [75% vs 87%, p=0.06]. In regression analysis, patients with PP > 60 were less likely to have TICI2b/TICI3 after controlling for age [OR 0.23 (95% CI 0.06 - 0.70), p=0.02], but no significant association was found with discharge mRS. Conclusions: The impact of PP on collateral flow in AIS and functional outcome should be studied further in larger AIS cohorts.