Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Fandler-Hoefler, S.
Peri- and postinterventional management of stroke patients treated with mechanical thrombectomy.
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Graz Medical University; 2020. pp.80.
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- Autor*innen der Med Uni Graz:
- Fandler-Höfler Simon
- Betreuer*innen:
- Berghold Andrea
- Enzinger Christian
- Gattringer Thomas
- Altmetrics:
- Abstract:
- Background Mechanical thrombectomy has become the primary treatment strategy for stroke due to large vessel occlusion of the anterior cerebral circulation. However, many questions regarding the optimal peri- and postinterventional management remain unanswered. We aimed to investigate the clinical impact of periinterventional blood pressure drops and of the duration of mechanical ventilation in stroke patients treated with mechanical thrombectomy. Methods We identified consecutive patients with stroke due to anterior circulation large vessel occlusion from our thrombectomy registry, in which clinical data were prospectively collected. For the investigation of periinterventional blood pressure, patients were included from January 2011 to June 2016. Periprocedural data were additionally extracted from electronic anaesthesia records, blood pressure was measured by invasive monitoring. For the examination of ventilation time, patients in the time period between January 2011 to April 2019 were included. The duration of ventilation time was both analysed as a continuous variable and grouped into extubation within six hours ("early"), 6-24 hours ("delayed") and >24 hours ("late"). The main outcome variable in both studies was favourable functional neurological outcome, defined as modified Rankin Scale scores of 0-2 at a follow-up examination three months post-stroke. Results We were able to analyse 115 patients with complete electronic periinterventional vital sign recordings and found that single severe blood pressure drops were associated with unfavourable outcome. The strongest effect was seen in mean arterial pressure drops below 60 mmHg (p=0.01), which remained independently associated with poor functional outcome in multivariable analysis (p<0.01). Regarding ventilation time, we included 441 patients with available follow-up data. Favourable outcome correlated with shorter ventilation time (Spearman’s Rho=0.39, p<0.001). Specifically, we found that extubation within six hours was associated with favourable outcome compared to delayed extubation (6-24 hours, odds ratio 2.40, p<0.001). This association remained statistically significant in multivariable analysis (p=0.01). Patients who were extubated after more than 24 hours often had severe stroke-related complications and generally much worse outcome. Conclusion Both the avoidance of severe periinterventional blood pressure drops and the strategy of early extubation after mechanical thrombectomy are associated with favourable outcome after three months in stroke patients and should therefore be recommended in the peri- and postinterventional stroke management.