Prognostic Significance of Pulse Pressure Variability During Mechanical Thrombectomy in Acute Ischemic Stroke Patients

BACKGROUND: Studies on the role of blood pressure (BP) variability specifically during mechanical thrombectomy (MT) are sparse and limited. Moreover, pulse pressure (PP) has not been considered as a potent hemodynamic parameter to describe BP variability during MT. We assessed the impact of PP variability on functional outcome in acute ischemic stroke patients with large vessel occlusion during MT. METHODS AND RESULTS: Acute ischemic stroke patients presenting with large vessel occlusion from January 2012 to June 2016 were included. BP data during MT were prospectively collected in the ETIS (Endovascular Treatment in Ischemic Stroke) registry. Logistic regression models were used to assess the association between PP coefficients of variation and functional outcome at 3 months (modified Rankin Scale). Among the 343 included patients, PP variability was significantly associated with worse 3‐month modified Rankin Scale in univariable (odds ratio [OR]=1.56, 95% confidence interval [CI]: 1.24–1.96 per 1‐unit increase, P=0.0002) and multivariable ordinal logistic regression (adjusted OR=1.40, 95% CI: 1.09–1.79, P=0.008). PP variability was also associated with unfavorable outcome (modified Rankin Scale 3–6) in univariable (OR=1.53, 95% CI: 1.17–2.01, P=0.002) and multivariable analysis (adjusted OR=1.42, 95% CI: 1.02–1.98, P=0.04). There was an association between PP variability and 3‐month all‐cause mortality in univariable analysis (OR= 1.37, 95% CI: 1.01–1.85 per 1‐unit increase of the coefficient of variation of the PP, P=0.04), which did not remain significant after adjustment for potential confounders. CONCLUSIONS: PP variability during MT is an independent predictor of worse clinical outcome in acute ischemic stroke patients. These findings support the need for a close monitoring of BP variability during MT. Whether pharmacological interventions aiming at reducing BP variability during MT could impact functional outcome needs to be determined.