Admission Blood Pressure and Clinical Outcomes After Endovascular Treatment for Acute Basilar Artery Occlusion

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Abstract BACKGROUND Basilar artery occlusion is a devastating subtype of stroke with low incidence. More than half of these patients fail to achieve favorable outcomes after endovascular treatment. Early blood pressure management may be an important determinant of prognosis; however, evidence for basilar artery occlusion remains limited and inconsistent. METHODS Patients with acute basilar artery occlusion who underwent endovascular treatment were screened using a prospective registry. The earliest non-invasive blood pressure measurements recorded in the emergency department were extracted. Associations between admission blood pressure and outcomes were analyzed using logistic regression for linear and restricted cubic splines for nonlinear trends. The primary outcome was favorable functional outcome at 90 days (modified Rankin Scale score ≤3). RESULTS A total of 387 patients with acute basilar artery occlusion treated with endovascular treatment were included in the analysis. Admission systolic and diastolic blood pressure showed inverted U-shaped associations with favorable functional outcomes, with thresholds of 154 and 97 mmHg, respectively. Relative to the threshold of 154 mmHg, each 10-mmHg increase in systolic blood pressure above the threshold was associated with reduced odds of a favorable outcome (adjusted OR, 0.71; 95% CI, 0.56-0.90), and each 10-mmHg decrease in systolic BP below the threshold was also associated with reduced odds of a favorable outcome (adjusted OR, 0.76; 95% CI, 0.58-0.99). Compared to the peak range (140–165 mmHg), systolic blood pressure both <140 mmHg and ≥165 mmHg were associated with lower odds of favorable outcomes (adjusted OR, 0.58; 95% CI, 0.35-0.95, adjusted OR, 0.66; 95% CI, 0.38-0.98, respectively). Higher blood pressure was linearly associated with a higher incidence of symptomatic intracranial hemorrhage. CONCLUSIONS In patients with acute basilar artery occlusion who underwent endovascular treatment, higher systolic and lower diastolic blood pressures were associated with a lower likelihood of favorable functional outcomes.

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