Cong Luo, Thanh N Nguyen, Rui Li, Chunrong Tao, Xiaozhong Jing, Pengfei Xu, Li Wang, Anmo Wang, Feiyang Gao, Ming Cai, Keyi Zhang, Min Chen, Xia Jiang, Nan Shen, Mohamad Abdalkader, Patrik Michel, Jeffrey L Saver, Raul G Nogueira, Xinfeng Liu, Wei Hu
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Intraprocedural BP data were extracted, with collateral status assessed using the Basilar Artery on CT Angiography (BATMAN) score (BATMAN score ≥7 favorable collateral status, <7 unfavorable). Associations between BP parameters and outcomes were assessed using multivariable logistic regression and restricted cubic splines. The effect modification was assessed using an interaction term between BP parameters and collateral status. The primary outcome was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0-3 at 90 days.</p><p><strong>Results: </strong>There were 212 patients included (median age 68 years, 32.1% female). Restricted cubic spline analysis showed that the SDs of systolic BP (SBP) and mean arterial pressure (MAP) had J-shaped relationships with favorable outcome (<i>p</i> for nonlinearity = 0.004 and <0.001, respectively), with inflection points at 12 and 8 mm Hg, respectively. Multivariable logistic regression showed that MAP of 80-110 mm Hg (adjusted odds ratio [aOR] 3.00, 95% CI 1.46-6.35) and MAP SD <8 mm Hg (aOR 2.28, 95% CI 1.24-4.25) were associated with favorable outcome. Significant interactions with collateral status were observed for MAP SD <8 mm Hg, SBP SD <12 mm Hg, MAP drop >20%, and minimum MAP and SBP (all <i>p</i><sub>interaction</sub> < 0.05). After Holm-Bonferroni correction, only the interaction between collateral status and MAP <80 mm Hg remained significant (corrected <i>p</i><sub>interaction</sub> = 0.036). In patients with unfavorable collateral status, MAP <80 mm Hg was associated with decreased probability of favorable outcome (aOR 0.04, 95% CI 0.00-0.21) while this association was not observed in patients with favorable collaterals.</p><p><strong>Discussion: </strong>For patients with BAO undergoing EVT, intraprocedural MAP between 80 and 110 mm Hg was associated with favorable outcome while MAP <80 mm Hg was associated with a lower probability of favorable outcome, especially in patients with unfavorable collateral status.</p>","PeriodicalId":19256,"journal":{"name":"Neurology","volume":"104 9","pages":"e213504"},"PeriodicalIF":7.7000,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association Between Collateral Status, Blood Pressure During Thrombectomy, and Clinical Outcomes in Patients With Basilar Artery Occlusion.\",\"authors\":\"Cong Luo, Thanh N Nguyen, Rui Li, Chunrong Tao, Xiaozhong Jing, Pengfei Xu, Li Wang, Anmo Wang, Feiyang Gao, Ming Cai, Keyi Zhang, Min Chen, Xia Jiang, Nan Shen, Mohamad Abdalkader, Patrik Michel, Jeffrey L Saver, Raul G Nogueira, Xinfeng Liu, Wei Hu\",\"doi\":\"10.1212/WNL.0000000000213504\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>We investigated the relationship between intraprocedural blood pressure (BP) and clinical outcomes in patients with basilar artery occlusion (BAO) undergoing endovascular treatment (EVT), exploring whether it is modifiable by collateral status.</p><p><strong>Methods: </strong>Patient data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) randomized trial were analyzed for those with BAO who received EVT. Intraprocedural BP data were extracted, with collateral status assessed using the Basilar Artery on CT Angiography (BATMAN) score (BATMAN score ≥7 favorable collateral status, <7 unfavorable). Associations between BP parameters and outcomes were assessed using multivariable logistic regression and restricted cubic splines. The effect modification was assessed using an interaction term between BP parameters and collateral status. The primary outcome was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0-3 at 90 days.</p><p><strong>Results: </strong>There were 212 patients included (median age 68 years, 32.1% female). Restricted cubic spline analysis showed that the SDs of systolic BP (SBP) and mean arterial pressure (MAP) had J-shaped relationships with favorable outcome (<i>p</i> for nonlinearity = 0.004 and <0.001, respectively), with inflection points at 12 and 8 mm Hg, respectively. Multivariable logistic regression showed that MAP of 80-110 mm Hg (adjusted odds ratio [aOR] 3.00, 95% CI 1.46-6.35) and MAP SD <8 mm Hg (aOR 2.28, 95% CI 1.24-4.25) were associated with favorable outcome. Significant interactions with collateral status were observed for MAP SD <8 mm Hg, SBP SD <12 mm Hg, MAP drop >20%, and minimum MAP and SBP (all <i>p</i><sub>interaction</sub> < 0.05). After Holm-Bonferroni correction, only the interaction between collateral status and MAP <80 mm Hg remained significant (corrected <i>p</i><sub>interaction</sub> = 0.036). 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引用次数: 0
摘要
背景与目的：我们研究了基底动脉闭塞（BAO）患者接受血管内治疗（EVT）时术中血压（BP）与临床结果的关系，探讨其是否会因侧支状态而改变。方法：对接受EVT治疗的BAO患者的血管内治疗急性基底动脉闭塞（ATTENTION）随机试验数据进行分析。提取术中血压数据，使用基底动脉CT血管造影（BATMAN）评分评估侧支状态（BATMAN评分≥7）。结果：纳入212例患者（中位年龄68岁，女性32.1%）。限制三次样条分析显示，收缩压（SBP）和平均动脉压（MAP）的SDs与预后良好呈j型关系（非线性p = 0.004和20%），最小MAP和收缩压（p < 0.05）。经Holm-Bonferroni修正后，只有抵押品地位与MAP之间的交互作用（交互作用= 0.036）。讨论：对于接受EVT的BAO患者，术中MAP在80 - 110 mm Hg之间与良好的结果相关
Association Between Collateral Status, Blood Pressure During Thrombectomy, and Clinical Outcomes in Patients With Basilar Artery Occlusion.
Background and objectives: We investigated the relationship between intraprocedural blood pressure (BP) and clinical outcomes in patients with basilar artery occlusion (BAO) undergoing endovascular treatment (EVT), exploring whether it is modifiable by collateral status.
Methods: Patient data from the Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) randomized trial were analyzed for those with BAO who received EVT. Intraprocedural BP data were extracted, with collateral status assessed using the Basilar Artery on CT Angiography (BATMAN) score (BATMAN score ≥7 favorable collateral status, <7 unfavorable). Associations between BP parameters and outcomes were assessed using multivariable logistic regression and restricted cubic splines. The effect modification was assessed using an interaction term between BP parameters and collateral status. The primary outcome was a favorable outcome defined by a modified Rankin Scale (mRS) score of 0-3 at 90 days.
Results: There were 212 patients included (median age 68 years, 32.1% female). Restricted cubic spline analysis showed that the SDs of systolic BP (SBP) and mean arterial pressure (MAP) had J-shaped relationships with favorable outcome (p for nonlinearity = 0.004 and <0.001, respectively), with inflection points at 12 and 8 mm Hg, respectively. Multivariable logistic regression showed that MAP of 80-110 mm Hg (adjusted odds ratio [aOR] 3.00, 95% CI 1.46-6.35) and MAP SD <8 mm Hg (aOR 2.28, 95% CI 1.24-4.25) were associated with favorable outcome. Significant interactions with collateral status were observed for MAP SD <8 mm Hg, SBP SD <12 mm Hg, MAP drop >20%, and minimum MAP and SBP (all pinteraction < 0.05). After Holm-Bonferroni correction, only the interaction between collateral status and MAP <80 mm Hg remained significant (corrected pinteraction = 0.036). In patients with unfavorable collateral status, MAP <80 mm Hg was associated with decreased probability of favorable outcome (aOR 0.04, 95% CI 0.00-0.21) while this association was not observed in patients with favorable collaterals.
Discussion: For patients with BAO undergoing EVT, intraprocedural MAP between 80 and 110 mm Hg was associated with favorable outcome while MAP <80 mm Hg was associated with a lower probability of favorable outcome, especially in patients with unfavorable collateral status.
期刊介绍：
Neurology, the official journal of the American Academy of Neurology, aspires to be the premier peer-reviewed journal for clinical neurology research. Its mission is to publish exceptional peer-reviewed original research articles, editorials, and reviews to improve patient care, education, clinical research, and professionalism in neurology.
As the leading clinical neurology journal worldwide, Neurology targets physicians specializing in nervous system diseases and conditions. It aims to advance the field by presenting new basic and clinical research that influences neurological practice. The journal is a leading source of cutting-edge, peer-reviewed information for the neurology community worldwide. Editorial content includes Research, Clinical/Scientific Notes, Views, Historical Neurology, NeuroImages, Humanities, Letters, and position papers from the American Academy of Neurology. The online version is considered the definitive version, encompassing all available content.
Neurology is indexed in prestigious databases such as MEDLINE/PubMed, Embase, Scopus, Biological Abstracts®, PsycINFO®, Current Contents®, Web of Science®, CrossRef, and Google Scholar.
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