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Publications

Journal Article Ppublish

PubMed: 41871383 DOI: 10.1093/esj/aakag012

BP-METROLOGY: non-invasive continuous blood pressure monitoring to predict haemorrhagic transformation after endovascular thrombectomy.

Eur Stroke J 11(3)

Authors: Arthur Matthys, Laurine Bedoucha, Florent Di Meglio, Candice Sabben, Michael Obadia, ChloƩ Le Cossec, Julien Labreuche, Perrine Boursin, Mikael Mazighi, Lucas Di Meglio

Affiliations

  • Neuroglial Interactions in Cerebral Physiology and Pathologies, Center for Interdisciplinary Research in Biology, CollĆØge de France, CNRS, INSERM, Labex Memolife, UniversitĆ© PSL, Paris, France. Medical Intensive Care Unit, Cochin Hospital, Assitance Publique HĆ“pitaux de Paris, APHP.Centre, Paris, France.
  • Department of Neurology, HĆ“pital LariboisiĆØre, UniversitĆ© Paris CitĆ©, Assitance Publique - HĆ“pitaux de Paris, Paris, France.
  • MINES ParisTech, UniversitĆ© PSL, Paris, France.
  • Department of Neurology, Stroke Unit, HĆ“pital Fondation Adolphe de Rothschild, Paris, France.
  • Clinical Research Unit, HĆ“pital Fondation Adolphe de Rothschild, Paris, France.
  • Department of Biostatistics, Centre Hospitalo-Universitaire de Lille, Lille, France.
  • Department of Interventional Neuroradiology, Stroke Unit, HĆ“pital Fondation Adolphe de Rothschild, Paris, France.
  • Optimisation ThĆ©rapeutique en Neuropharmacologie (INSERM UMR-S 1144), UniversitĆ© Paris CitĆ©, Paris, France.
  • Institut Universitaire de France, Paris, France.
  • FHU NeuroVasc2030, Paris, France.
  • Cardiovascular MArkers in Stressed COndiTions (INSERM UMR 942 MASCOT), UniversitĆ© Paris CitĆ©, 2 rue Ambroise ParĆ©, 75010 Paris, France.

Abstract

INTRODUCTION

Haemorrhagic transformation (HT) seriously worsens functional outcome after endovascular therapy (EVT). Blood pressure (BP) variability may influence HT risk, but optimal monitoring strategies remain unclear. We aimed to determine whether continuous BP monitoring better identifies patients at risk of HT than standard intermittent measurements during the first 24Ā h post-EVT.

PATIENTS AND METHODS

We conducted a single-centre prospective cohort study including adults with acute ischaemic stroke due to large-vessel occlusion treated with EVT. Non-invasive finger-cuff continuous BP and arm-cuff intermittent BP were recorded simultaneously for 24Ā h post-EVT. Haemorrhagic transformation on follow-up brain imaging at 24-36Ā h was the primary outcome. Blood pressure recordings were partitioned into three 8-h windows. Variability metrics (mean, maximum, range, SD, coefficient of variation and wavelet-based coefficient energies) were processed into logistic regression models adjusted for clinical covariates. Predictive performance was assessed using AUC-ROC.

RESULTS

Among 455 enrolled patients, 199 contributed data to the first 8-h window, in which HT occurred in 58 (29%). Continuous BP variability features, particularly maximum, range and wavelet energies capturing <ā€‰32-min fluctuations, were significantly associated with HT, whereas no parameter from intermittent monitoring showed such an association. A multivariable model using continuous data yielded an AUC-ROC of 0.62 (95% CI, 0.54-0.71) vs 0.48 (95% CI, 0.37-0.58) for intermittent data. Associations were not observed in later windows.

DISCUSSION AND CONCLUSION

Short-timescale BP variability captured by continuous monitoring in the first 8Ā h post-EVT is associated with increased HT risk, whereas intermittent monitoring fails to detect this signal and may miss opportunities for early risk stratification.

MeSH

Blood, Stroke, Blood Pressure, Thrombectomy