TY - JOUR
T1 - Baseline Blood Pressure Effect on the Benefit and Safety of Intra-Arterial Treatment in MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands)
AU - Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands (MR CLEAN) Investigators
AU - Mulder, Maxim J H L
AU - Ergezen, Saliha
AU - Lingsma, Hester F
AU - Berkhemer, Olvert A
AU - Fransen, Puck S S
AU - Beumer, Debbie
AU - van den Berg, Lucie A
AU - Lycklama À Nijeholt, Geert
AU - Emmer, Bart J
AU - van der Worp, H Bart
AU - Nederkoorn, Paul J
AU - Roos, Yvo B W E M
AU - van Oostenbrugge, Robert J
AU - van Zwam, Wim H
AU - Majoie, Charles B L M
AU - van der Lugt, Aad
AU - Dippel, Diederik W J
AU - AUTHOR GROUP
AU - Schonewille, Wouter J.
AU - Vos, Jan Albert
AU - Wermer, Marieke J. H.
AU - van Walderveen, Marianne A. A.
AU - Staals, Julie
AU - Hofmeijer, Jeannette
AU - van Oostayen, Jacques A.
AU - Boiten, Jelis
AU - Brouwer, Patrick A.
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - Kappelle, L. Jaap
AU - Lo, Rob H.
AU - van Dijk, Ewoud J.
AU - de Vries, Joost
AU - de Kort, Paul L. M.
AU - van den Berg, Jan S. P.
AU - van Rooij, Willem Jan J.
AU - van Hasselt, Boudewijn A. A. M.
AU - Aerden, Leo A. M.
AU - Dallinga, René J.
AU - Visser, Marieke C.
AU - Bot, Joseph C. J.
AU - Vroomen, Patrick C.
AU - Eshghi, Omid
AU - Schreuder, Tobien H. C. M. L.
AU - Heijboer, Roel J. J.
AU - Keizer, Koos
AU - Tielbeek, Alexander V.
AU - Marquering, Henk A.
AU - Beenen, Ludo F.
AU - Sprengers, Marieke E. S.
AU - van den Berg, René
PY - 2017/7
Y1 - 2017/7
N2 - BACKGROUND AND PURPOSE: High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT.METHODS: This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms.RESULTS: Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09-1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP.CONCLUSIONS: BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP.CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758.
AB - BACKGROUND AND PURPOSE: High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT.METHODS: This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms.RESULTS: Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09-1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP.CONCLUSIONS: BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP.CLINICAL TRIAL REGISTRATION: URL: http://www.isrctn.com. Unique identifier: ISRCTN10888758.
KW - Aged
KW - Blood Pressure
KW - Brain Ischemia
KW - Endovascular Procedures
KW - Female
KW - Humans
KW - Intracranial Hemorrhages
KW - Journal Article
KW - Male
KW - Middle Aged
KW - Multicenter Study
KW - Netherlands
KW - Outcome Assessment (Health Care)
KW - Randomized Controlled Trial
KW - Retrospective Studies
KW - Stroke
U2 - https://doi.org/10.1161/STROKEAHA.116.016225
DO - https://doi.org/10.1161/STROKEAHA.116.016225
M3 - Article
C2 - 28432266
SN - 0039-2499
VL - 48
SP - 1869
EP - 1876
JO - Stroke
JF - Stroke
IS - 7
ER -