Introduction
Methods
Design of the KEEP SIMPLEST Study
Data Collection
Exposures
Outcomes
Statistical analysis
Data Collection Statement
Results
Patient Characteristics
n (%) | |
---|---|
Demographic characteristics (n = 139) | |
Age, mean (SD) (years) | 76.0 (10.9) |
Female sex | 82 (59.0) |
Premedication | |
Antiplatelet therapy | 50 (36.0) |
Oral anticoagulant therapy | 22 (15.8) |
Statin | 39 (28.1) |
Vascular risk factors | |
Hypertension | 115 (82.7) |
Diabetes mellitus | 34 (24.5) |
Hyperlipidemia | 37 (26.6) |
Smoking | 22 (15.8) |
Atrial fibrillation | 46 (33.1) |
Peripheral artery occlusive disease | 14 (10.1) |
Premorbid mRS score | |
0 | 47 (33.8) |
1 | 34 (24.5) |
2 | 20 (14.4) |
> 2 | 38 (27.3) |
NIHSS score | |
Mean (SD) | 14.3 (7.5) |
Median (IQR) | 14.0 (8–20) |
Site of arterial occlusion | |
ICA occlusion | 43 (27.2) |
MCA occlusion | 95 (68.3) |
ICA + MCA occlusion | 38 (23.6) |
Left side | 70 (43.5) |
Treatment | |
Alteplase only | 6 (4.3) |
Alteplase + EST | 81 (58.3) |
EST only | 52 (37.4) |
Door-to-needle time, mean (SD)a (min) | 32.0 (13.0) |
Pretreatment ASPECTSb | |
8–10 | 89 (65.9) |
6–7 | 31 (23.0) |
< 6 | 15 (11.1) |
Median (IQR) | 8 (7–10) |
Periinterventional aspects | |
Conversion to general anesthesiac | 14 (10.1) |
Need of sedation | 127 (91.4) |
Need of catecholamines | 43 (30.9) |
MAP reduction of at least 20%d | 67 (49.3) |
MAP reduction of at least 30%d | 33 (24.3) |
MAP reduction of at least 40%d | 13 (9.6) |
MAP < 70 mm Hg | 7 (5.0) |
Functional outcome parameters (n = 139) | |
NIHSS score change after 24 h, mean (SD) | − 3.8 (9.0) |
mRS score after 3 mo | |
0–1 | 37 (26.6) |
0–2 | 77 (55.4) |
0–3 | 80 (57.6) |
In-house mortality | 10 (7.2) |
Mortality after 3 mo | 28 (20.1) |
Degree of reperfusion (TICI grade) (n = 161e) | |
0–2a | 22 (13.6) |
2b | 70 (43.5) |
2c | 19 (11.8) |
3 | 50 (31.1) |
Phase | Mean SBP (SD) (mm Hg) | Mean DBP (SD) (mm Hg) | Mean MAP (SD) (mm Hg) | n |
---|---|---|---|---|
Baseline | 169.5 (24.5) | 92.7 (15.7) | 118.3 (16.5) | 136 |
Pre-recanalization | 155.4 (19.1) | 84.1 (11.3) | 107.0 (12.5) | 139 |
Post recanalization | 151.4 (22.6) | 80.6 (13.7) | 104.2 (15.0) | 136 |
Post intervention | 147.2 (23.3) | 76.7 (13.7) | 100.2 (15.5) | 137 |
Phase | ΔSBP (SD) (mm Hg) | ΔDBP (SD) (mm Hg) | ΔMAP (SD) (mm Hg) | n |
---|---|---|---|---|
Baseline to pre-recanalization | − 13.9 (23.0) | − 8.5 (15.4) | − 10.3 (16.5) | 136 |
Baseline to post recanalization | − 18.0 (26.7) | − 12.0 (16.3) | − 14.0 (18.3) | 136 |
Baseline to post intervention | − 22.3 (29.4) | − 16.0 (17.4) | − 18.1 (19.6) | 136 |
Association of BP with Reperfusion Status
Association of BP with Early Neurological Improvement
Phase | β | 95% CI | P |
---|---|---|---|
SBP during different phases | |||
Baseline | 0.12 | 0.04 to 0.19 | 0.002 |
Pre-recanalization | 0.18 | 0.08 to 0.29 | < 0.001 |
Post-recanalization | 0.12 | 0.03 to 0.20 | 0.006 |
Postintervention | 0.07 | − 0.01 to 0.16 | 0.103 |
ΔSBP between different phases | |||
From baseline to pre-recanalization | 0.01 | − 0.08 to 0.10 | 0.759 |
From baseline to post-recanalization | 0.03 | − 0.10 to 0.16 | 0.663 |
From baseline to postintervention | 0.05 | − 0.02 to 0.12 | 0.134 |
DBP during different phases | |||
Baseline | − 0.08 | − 0.21 to 0.04 | 0.185 |
Pre-recanalization | − 0.19 | − 0.36 to − 0.02 | 0.029 |
Post-recanalization | − 0.12 | − 0.26 to 0.02 | 0.082 |
Postintervention | − 0.13 | − 0.28 to 0.01 | 0.076 |
ΔDBP between different phases | |||
From baseline to pre-recanalization | 0.02 | − 0.12 to 0.15 | 0.812 |
From baseline to post-recanalization | − 0.01 | − 0.10 to 0.08 | 0.845 |
From baseline to postintervention | 0.02 | − 0.11 to 0.14 | 0.781 |
MAP during different phases | |||
Baseline | 0.09 | 0.00 to 0.18 | 0.063 |
Pre-recanalization | 0.08 | − 0.04 to 0.21 | 0.176 |
Post-recanalization | 0.05 | − 0.05 to 0.15 | 0.344 |
Postintervention | − 0.01 | − 0.11to 0.09 | 0.807 |
ΔMAP between different phases | |||
From baseline to pre-recanalization | 0.03 | − 0.06 to 0.13 | 0.492 |
From baseline to post-recanalization | 0.04 | − 0.05 to 0.12 | 0.423 |
From baseline to postintervention | 0.09 | 0.01 to 0.17 | 0.036 |
Association of BP with mRS Score 0–2 at 3 Months
Phase | OR | 95% confidence interval | P |
---|---|---|---|
SBP during different phases | |||
Baseline | 0.76 | 0.61–0.95 | 0.015 |
Pre-recanalization | 0.65 | 0.47–0.91 | 0.011 |
Post-recanalization | 0.84 | 0.66–1.06 | 0.136 |
Postintervention | 0.85 | 0.66–1.08 | 0.184 |
ΔSBP between different phases | |||
From baseline to pre-recanalization | 0.95 | 0.75–1.20 | 0.642 |
From baseline to post-recanalization | 0.93 | 0.75–1.16 | 0.529 |
From baseline to postintervention | 0.88 | 0.71–1.08 | 0.222 |
DBP during different phases | |||
Baseline | 1.12 | 0.78–1.61 | 0.539 |
Pre-recanalization | 1.19 | 0.70–2.00 | 0.523 |
Post-recanalization | 1.24 | 0.84–1.82 | 0.274 |
Postintervention | 1.54 | 0.99–2.40 | 0.055 |
ΔDBP between different phases | |||
From baseline to pre-recanalization | 1.12 | 0.78–1.61 | 0.548 |
From baseline to post-recanalization | 0.99 | 0.69–1.42 | 0.939 |
From baseline to postintervention | 0.88 | 0.62–1.25 | 0.464 |
MAP during different phases | |||
Baseline | 0.76 | 0.58–1.00 | 0.050 |
Pre-recanalization | 0.66 | 0.45–0.96 | 0.030 |
Post-recanalization | 0.95 | 0.71–1.27 | 0.715 |
Postintervention | 1.10 | 0.83–1.46 | 0.499 |
ΔMAP between different phases | |||
From baseline to pre-recanalization | 1.02 | 0.78–1.33 | 0.874 |
From baseline to post-recanalization | 0.90 | 0.70–1.14 | 0.376 |
From baseline to postintervention | 0.75 | 0.58–0.98 | 0.032 |