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

Abstract

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 (SBP_mean, SBP_max, SBP_max-min, and MAP_mean) 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 SBP_mean, SBP_max, and MAP_mean were 150 ± 26 mmHg, 173 ± 29 mmHg, and 101 ± 17 mmHg, respectively. The median maximum iodine concentration on post-EVT DECT was 1.2 mg/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. SBP_mean, SBP_max, and MAP_mean 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 patients achieving successful recanalization, SBP_mean, SBP_max, and MAP_mean are associated with the extent of BBBD on immediate post-EVT DECT, but not with maximum iodine concentration.

Keywords: Acute ischemic stroke; Blood brain barrier; Blood pressure; Dual energy computed tomography.