Blood pressure during endovascular treatment under conscious sedation or local anesthesia.

Samuels, Noor; van de Graaf, Rob A; van den Berg, Carlijn A L; Nieboer, Daan; Eralp, Ismail; Treurniet, Kilian M; Emmer, Bart J; Immink, Rogier V; Majoie, Charles B L M; van Zwam, Wim H; Bokkers, Reinoud P H; Uyttenboogaart, Maarten; van Hasselt, Boudewijn A A M; Mühling, Jörg; Burke, James F; Roozenbeek, Bob; van der Lugt, Aad; Dippel, Diederik W J; Lingsma, Hester F; van Es, Adriaan C G M

OBJECTIVE To evaluate the role of blood pressure as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after EVT. METHODS Patients treated in MR CLEAN Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP) and procedural blood pressure trend, compared to LA. Second, we assessed the association between blood pressure and functional outcome (modified Rankin Scale, mRS) with multivariable regression. Lastly, we evaluated whether blood pressure explained the effect of CS on mRS. RESULTS In 440 patients with available blood pressure data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%) and a more negative blood pressure trend (-0.22 vs -0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common OR (acOR) per 10%-drop 0.87, 95%CI 0.78-0.97, and acOR per 300 mm Hg*min 0.89, 95%CI 0.82-0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95%CI 0.40-0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95%CI0.42-0.92). CONCLUSIONS Large blood pressure drops are associated with worse functional outcome. However, blood pressure drops do not explain the worse outcomes in the CS group.