Characteristics of Blood Pressure Profiles after Endovascular Coiling as Predictors of Clinical Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage.

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Characteristics of Blood Pressure Profiles after Endovascular Coiling as Predictors of Clinical Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage.

World Neurosurg. 2017 May 13;:

Authors: Cai K, Zhang Y, Shen L, Ji Q, Xu T, Cao M

Abstract
OBJECTIVE: Accurate identification of patients who will achieve a favorable outcome is almost impossible preoperatively or postoperatively in poor-grade (Hunt and Hess Grade IV and V) aneurysmal subarachnoid hemorrhage (SAH). Whether characteristics of blood pressure profiles during the first 24 hours after endovascular coiling could predict prognosis in poor grade patients was explored.
METHODS: Data were retrospectively obtained on all patients undergoing endovascular treatment with poor-grade SAH from Nov. 2011 to Jun. 2016. Blood pressure during the initial 24 hours was measured at 2-hour intervals after coil embolization. Studied features of mean systolic blood pressure (MSBP) and systolic blood pressure variability (SBPV) as well as demographics, medical history, clinical characteristics, and neurological outcomes were documented. SBPV was determined as standard deviation (SD) and successive variation (SV) of systolic blood pressure (SBP). Logistic regression analysis was used to identify predictors of favorable outcome assessed on modified Rankin Scale score of 0 to 2.
RESULTS: The patients with favorable and unfavorable outcome were comparable with respect to SBP on admission and MSBP after coiling. However, MSBP between 120 mmHg and 140 mmHg was independent predictors of good outcomes at discharge (odds ratio [OR], 7.1; P=0.002). SBPV-SV after embolization was associated with functional recovery (OR, 0.87; P=0.011) in multivariate logistic analysis and mortality by Cox proportional hazard regression (Hazard ratio, 1.10; P=0.001) at 6-month follow-up.
CONCLUSIONS: Characteristics of blood pressure profiles after coiling appear to be simple and convenient indexes for the prognosis of patients with poor-grade SAH.

PMID: 28512041 [PubMed - as supplied by publisher]

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