{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T20:26:22Z","timestamp":1790972782304,"version":"4.1.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2020,1,18]],"date-time":"2020-01-18T00:00:00Z","timestamp":1579305600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,1,18]],"date-time":"2020-01-18T00:00:00Z","timestamp":1579305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>We examined the influence of periprocedural blood pressure (BP), especially critical BP drops, on 3-month functional outcome in stroke patients undergoing mechanical thrombectomy (MT) under general anaesthesia (GA).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>We screened all patients with anterior circulation large vessel occlusion receiving MT under GA at our centre from January 2011 to June 2016 and selected those who had continuous invasive periinterventional BP monitoring. Clinical and radiological data were prospectively collected as part of an ongoing cohort study, monitoring data were extracted from electronic anaesthesia records. We used uni- and multivariable regression to investigate the association of BP values with unfavourable outcome, defined as modified Rankin Scale scores 3\u20136 3\u00a0months post-stroke.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>115 patients were included in this study (mean age 65.3\u2009\u00b1\u200913.0\u00a0years, 55.7% male). Periinterventional systolic, diastolic, and mean arterial BP (MAP) values averaged across MT had no effect on outcome. However, single BP drops were related to unfavourable outcome, with absolute MAP drops showing the highest association compared to both systolic and relative BP drops (with reference to pre-interventional values). The BP value with the strongest association with unfavourable outcome was identified as an MAP ever\u2009&lt;\u200960\u00a0mmHg (<jats:italic>p<\/jats:italic>\u2009=\u20090.01) with a pronounced effect in patients with poor collaterals. An MAP\u2009&lt;\u200960\u00a0mmHg remained independently associated with poor functional outcome in multivariable analysis (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>For patients undergoing MT under GA, single MAP drops\u2009&lt;\u200960\u00a0mmHg are independently related to unfavourable 3-month outcome. Therefore, every effort should be made to prevent periinterventional hypotensive episodes, especially below this threshold.<\/jats:p>\n<\/jats:sec>","DOI":"10.1007\/s00415-020-09701-x","type":"journal-article","created":{"date-parts":[[2020,1,18]],"date-time":"2020-01-18T06:02:40Z","timestamp":1579327360000},"page":"1331-1339","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Single mean arterial blood pressure drops during stroke thrombectomy under general anaesthesia are associated with poor outcome"],"prefix":"10.1007","volume":"267","author":[{"given":"Simon","family":"Fandler-H\u00f6fler","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Heschl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Placido","family":"Arg\u00fcelles-Delgado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Kneihsl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Hassler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marton","family":"Magyar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Kainz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Berghold","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Niederkorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Deutschmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Fazekas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6065-6576","authenticated-orcid":false,"given":"Thomas","family":"Gattringer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,1,18]]},"reference":[{"issue":"10029","key":"9701_CR1","doi-asserted-by":"publisher","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","volume":"387","author":"M Goyal","year":"2016","unstructured":"Goyal M, Menon BK, van Zwam WH et al (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387(10029):1723\u20131731","journal-title":"Lancet"},{"issue":"4","key":"9701_CR2","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1001\/jamaneurol.2017.4474","volume":"75","author":"CZ Simonsen","year":"2018","unstructured":"Simonsen CZ, Yoo AJ, S\u00f8rensen LH et al (2018) Effect of general anesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischemic stroke: a randomized clinical trial. JAMA Neurol 75(4):470\u2013477","journal-title":"JAMA Neurol"},{"issue":"6","key":"9701_CR3","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.1161\/STROKEAHA.117.016554","volume":"48","author":"P L\u00f6whagen Hend\u00e9n","year":"2017","unstructured":"L\u00f6whagen Hend\u00e9n P, Rentzos A, Karlsson J-E et al (2017) General anesthesia versus conscious sedation for endovascular treatment of acute ischemic stroke: the AnStroke Trial (Anesthesia During Stroke). Stroke 48(6):1601\u20131607","journal-title":"Stroke"},{"issue":"19","key":"9701_CR4","doi-asserted-by":"publisher","first-page":"1986","DOI":"10.1001\/jama.2016.16623","volume":"316","author":"S Sch\u00f6nenberger","year":"2016","unstructured":"Sch\u00f6nenberger S, Uhlmann L, Hacke W et al (2016) Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA 316(19):1986\u20131996","journal-title":"JAMA"},{"issue":"10","key":"9701_CR5","doi-asserted-by":"publisher","first-page":"2784","DOI":"10.1161\/STROKEAHA.117.017786","volume":"48","author":"W Brinjikji","year":"2017","unstructured":"Brinjikji W, Pasternak J, Murad MH et al (2017) Anesthesia-related outcomes for endovascular stroke revascularization: a systematic review and meta-analysis. Stroke 48(10):2784\u20132791","journal-title":"Stroke"},{"issue":"1","key":"9701_CR6","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1016\/S1474-4422(17)30407-6","volume":"17","author":"BCV Campbell","year":"2018","unstructured":"Campbell BCV, van Zwam WH, Goyal M et al (2018) Effect of general anaesthesia on functional outcome in patients with anterior circulation ischaemic stroke having endovascular thrombectomy versus standard care: a meta-analysis of individual patient data. Lancet Neurol 17(1):47\u201353","journal-title":"Lancet Neurol"},{"issue":"1","key":"9701_CR7","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1093\/bja\/aex127","volume":"119","author":"S S\u00fcdfeld","year":"2017","unstructured":"S\u00fcdfeld S, Brechnitz S, Wagner JY et al (2017) Post-induction hypotension and early intraoperative hypotension associated with general anaesthesia. Br J Anaesth 119(1):57\u201364","journal-title":"Br J Anaesth"},{"issue":"9","key":"9701_CR8","doi-asserted-by":"publisher","first-page":"2678","DOI":"10.1161\/STROKEAHA.115.009808","volume":"46","author":"P L\u00f6whagen Hend\u00e9n","year":"2015","unstructured":"L\u00f6whagen Hend\u00e9n P, Rentzos A, Karlsson J-E et al (2015) Hypotension during endovascular treatment of ischemic stroke is a risk factor for poor neurological outcome. Stroke 46(9):2678\u20132680","journal-title":"Stroke"},{"issue":"2","key":"9701_CR9","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1007\/s12028-013-9921-3","volume":"20","author":"CE Takahashi","year":"2014","unstructured":"Takahashi CE, Brambrink AM, Aziz MF et al (2014) Association of intraprocedural blood pressure and end tidal carbon dioxide with outcome after acute stroke intervention. Neurocrit Care 20(2):202\u2013208","journal-title":"Neurocrit Care"},{"issue":"2","key":"9701_CR10","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1136\/neurintsurg-2017-012988","volume":"10","author":"KM Treurniet","year":"2018","unstructured":"Treurniet KM, Berkhemer OA, Immink RV et al (2018) A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia. J Neurointerv Surg 10(2):107\u2013111","journal-title":"J Neurointerv Surg"},{"issue":"6","key":"9701_CR11","doi-asserted-by":"publisher","first-page":"1451","DOI":"10.1161\/STROKEAHA.117.019709","volume":"49","author":"S Sch\u00f6nenberger","year":"2018","unstructured":"Sch\u00f6nenberger S, Uhlmann L, Ungerer M et al (2018) Association of blood pressure with short- and long-term functional outcome after stroke thrombectomy: post hoc analysis of the SIESTA trial. Stroke 49(6):1451\u20131456","journal-title":"Stroke"},{"issue":"3","key":"9701_CR12","doi-asserted-by":"publisher","first-page":"373","DOI":"10.5853\/jos.2018.01305","volume":"20","author":"S Pikija","year":"2018","unstructured":"Pikija S, Trkulja V, Ramesmayer C et al (2018) Higher blood pressure during endovascular thrombectomy in anterior circulation stroke is associated with better outcomes. J Stroke 20(3):373\u2013384","journal-title":"J Stroke"},{"issue":"3","key":"9701_CR13","doi-asserted-by":"publisher","first-page":"e46","DOI":"10.1161\/STR.0000000000000158","volume":"49","author":"WJ Powers","year":"2018","unstructured":"Powers WJ, Rabinstein AA, Ackerson T et al (2018) 2018 Guidelines for the early management of patients with acute ischemic stroke: a Guideline for Healthcare Professionals from the American Heart Association\/American Stroke Association. Stroke 49(3):e46\u2013e99","journal-title":"Stroke"},{"issue":"8","key":"9701_CR14","doi-asserted-by":"publisher","first-page":"e138","DOI":"10.1161\/STROKEAHA.113.003412","volume":"45","author":"PO Talke","year":"2014","unstructured":"Talke PO, Sharma D, Heyer EJ, Bergese SD, Blackham KA, Stevens RD (2014) Republished: Society for Neuroscience in Anesthesiology and Critical Care expert consensus statement: Anesthetic management of endovascular treatment for acute ischemic stroke. Stroke 45(8):e138\u2013150","journal-title":"Stroke"},{"issue":"6","key":"9701_CR15","doi-asserted-by":"publisher","first-page":"2C","DOI":"10.1016\/0002-9149(89)90396-2","volume":"63","author":"OB Paulson","year":"1989","unstructured":"Paulson OB, Waldemar G, Schmidt JF, Strandgaard S (1989) Cerebral circulation under normal and pathologic conditions. Am J Cardiol 63(6):2C\u20135C","journal-title":"Am J Cardiol"},{"issue":"4","key":"9701_CR16","doi-asserted-by":"publisher","first-page":"695","DOI":"10.1213\/ANE.0000000000004044","volume":"128","author":"BJ Hindman","year":"2019","unstructured":"Hindman BJ (2019) Anesthetic management of emergency endovascular thrombectomy for acute ischemic stroke, part 1: patient characteristics, determinants of effectiveness, and effect of blood pressure on outcome. Anesth Analg 128(4):695\u2013705","journal-title":"Anesth Analg"},{"issue":"3","key":"9701_CR17","doi-asserted-by":"publisher","first-page":"525","DOI":"10.3174\/ajnr.A1408","volume":"30","author":"IYL Tan","year":"2009","unstructured":"Tan IYL, Demchuk AM, Hopyan J et al (2009) CT angiography clot burden score and collateral score: correlation with clinical and radiologic outcomes in acute middle cerebral artery infarct. Am J Neuroradiol 30(3):525\u2013531","journal-title":"Am J Neuroradiol"},{"issue":"2","key":"9701_CR18","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1159\/000368595","volume":"39","author":"NH Petersen","year":"2015","unstructured":"Petersen NH, Ortega-Gutierrez S, Reccius A, Masurkar A, Huang A, Marshall RS (2015) Dynamic cerebral autoregulation is transiently impaired for 1 week after large-vessel acute ischemic stroke. Cerebrovasc Dis 39(2):144\u2013150","journal-title":"Cerebrovasc Dis"},{"issue":"6","key":"9701_CR19","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1097\/ALN.0000000000001625","volume":"126","author":"L Rivera-Lara","year":"2017","unstructured":"Rivera-Lara L, Zorrilla-Vaca A, Geocadin RG, Healy RJ, Ziai W, Mirski MA (2017) Cerebral autoregulation-oriented therapy at the bedside: a comprehensive review. Anesthesiology 126(6):1187\u20131199","journal-title":"Anesthesiology"},{"issue":"5","key":"9701_CR20","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1161\/HYPERTENSIONAHA.113.01867","volume":"62","author":"J Liu","year":"2013","unstructured":"Liu J, Zhu Y-S, Hill C et al (2013) Cerebral autoregulation of blood velocity and volumetric flow during steady-state changes in arterial pressure. Hypertension 62(5):973\u2013979","journal-title":"Hypertension"},{"issue":"12","key":"9701_CR21","doi-asserted-by":"publisher","first-page":"2004","DOI":"10.1007\/s00134-010-1970-x","volume":"36","author":"EC Boerma","year":"2010","unstructured":"Boerma EC, Ince C (2010) The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients. Intensive Care Med 36(12):2004\u20132018","journal-title":"Intensive Care Med"},{"issue":"2","key":"9701_CR22","doi-asserted-by":"publisher","first-page":"216","DOI":"10.1097\/00005373-199302000-00006","volume":"34","author":"RM Chesnut","year":"1993","unstructured":"Chesnut RM, Marshall LF, Klauber MR et al (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34(2):216\u2013222","journal-title":"J Trauma"},{"issue":"10","key":"9701_CR23","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1016\/S1474-4422(11)70195-8","volume":"10","author":"A Shuaib","year":"2011","unstructured":"Shuaib A, Butcher K, Mohammad AA, Saqqur M, Liebeskind DS (2011) Collateral blood vessels in acute ischaemic stroke: a potential therapeutic target. Lancet Neurol 10(10):909\u2013921","journal-title":"Lancet Neurol"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-020-09701-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s00415-020-09701-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-020-09701-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,17]],"date-time":"2021-01-17T00:35:38Z","timestamp":1610843738000},"score":1,"resource":{"primary":{"URL":"http:\/\/link.springer.com\/10.1007\/s00415-020-09701-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,1,18]]},"references-count":23,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2020,5]]}},"alternative-id":["9701"],"URL":"https:\/\/doi.org\/10.1007\/s00415-020-09701-x","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,1,18]]},"assertion":[{"value":"27 October 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 January 2020","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 January 2020","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 January 2020","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"The study was approved by the ethics committee of the Medical University of Graz in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Informed consent was waived by the ethics committee due to the retrospective nature of this study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}