The article I chose is an observational, retrospective, single-center study that looked to see if exceeding systolic blood pressure targets in patients during the 1st 24 hours after successful mechanical thrombectomy led to worse outcomes. In this study, poor outcomes were defined as discharge to skilled nursing facility, long-term care facility, hospice care or death. Patients in the study were categorized into 3 different groups according to cases of SBP exceeding 140, 160, or 180 mmgHg. Primary and secondary outcomes were the modified Rankin scale score at discharge and 90 days of follow-up, the incidence of symptomatic intracranial hemorrhage, malignant cerebral edema, hemicraniectomy, mortality within 90 days, and discharge disposition. The article discussed the fact that there are multiple studies that examine outcomes with different SBP targets with data the conflict with available data from previous observational studies. In this particular study, 117 patients met the inclusion criteria with a mean age of 65 and 53% of patients were women. There were also covariates amongst the 3 blood pressure groups including, hypertension, antihypertensive infusions, and as needed antihypertensive medications. The use of vasopressors was treated as a covariate for multivariate analysis in the SBP >/= 140-mm Hg cohort. Atrial fibrillation, anticoagulant use, and pretreatment NIHSS score were treated as covariates in the SBP >/= 160-mm Hg cohort; and large vessel etiology and tandem occlusion were treated as covariates in the SBP >/= 180-mm Hg cohort. The occurrence of >/= 1 instance of SBP >/= 180 mm Hg was significantly associated with poor functional outcomes at discharge, but not at 90 days of follow up. Patients with SBP >/= 140 mm Hg and 160 mm Hg had significantly worse mean mRS scores at 90 days of follow-up. The occurrence of SBP >/= 160 mm Hg also resulted in an independently increased odds of malignant cerebral edema. Based on the data it was concluded that an SBP of >/=180 mm Hg at least once during the 24-hour period after successful MT for AIS in the setting of a large vessel occlusion does lead to worse functional outcomes at discharge but not after 90 days.
