Procedural blood pressure and contrast extravasation on dual energy computed tomography after endovascular stroke treatment.

BACKGROUND: Blood brain barrier disruption (BBBD) can be visualized by contrast extravasation (CE) after endovascular treatment (EVT) in patients with acute ischemic stroke. Elevated blood pressure is a risk factor for BBBD. However, the association between procedural blood pressure and CE post-EVT is unknown.

METHODS: In this single-center retrospective study, we analyzed 501 eligible patients who received a dual energy CT (DECT) immediately post-EVT for acute ischemic stroke. Procedural blood pressure values (SBPmean , SBPmax, SBPmax-min, and MAPmean ) were collected. CE was quantified by measuring the maximum parenchymal iodine concentration on DECT iodine overlay map reconstructions. As a measure for the extent of BBBD, we created CE-ASPECTS by deducting one point per hyperdense ASPECTS region on iodine overlay maps. The association between blood pressure and CE was assessed using multivariable linear regression.

RESULTS: The procedural SBPmean , SBPmax , and MAPmean were 150±26 mmHg, 173±29 mmHg, and 101±17 mmHg, respectively. The median maximum iodine concentration on post-EVT DECT was 1.2mg/ml (IQR 0.7-2.0), and median CE-ASPECTS was 8 (IQR 5-11). The maximum iodine concentration was not associated with blood pressure. SBPmean , SBPmax, and MAPmean were significantly associated with CE-ASPECTS (per 10 mmHg, β = -0.2, 95% CI -0.31 to -0.09, β = -0.15, 95% CI -0.25 to -0.06, β = -0.33, 95% CI -0.49 to -0.17, respectively).

CONCLUSION: In acute ischemic stroke patients undergoing EVT, particularly in ones gaining successful recanalization, SBPmean , SBPmax , and MAPmean are associated with the extent of BBBD on immediate post-EVT DECT, but not with maximum iodine concentration.