Effect of personalized blood pressure management during mechanical thrombectomy under general anesthesia: a single-center before–after study

INTRODUCTION: Blood pressure (BP) variability, particularly arterial hypotension during mechanical thrombectomy (MT) for acute ischemic stroke (AIS), has been associated with unfavorable outcomes. This variability in BP is notably present during induction in general anesthesia (GA). This study seeks to assess the effectiveness of a personalized BP management protocol during MT under general GA in mitigating hypotension and its impact on functional outcomes at 90 days. METHODS: We conducted a monocentric before-after study involving two retrospective cohorts of patients who underwent MT for AIS under GA, before and after implementing the protocol. The protocol aimed to maintain the mean arterial pressure (MAP) within 10% of the baseline MAP prior to induction. The main outcome measured was the modified Rankin Scale (mRS) at 90 days. RESULTS: Our analysis included 179 patients: 121 before and 58 after protocol implementation. The "after" group showed a reduced proportion of MAP drops, especially severe hypotension (32.8% vs. 48.8% below 30% from baseline, and 51.7% vs. 66.1% below 20%). However, these differences lacked statistical significance. At 90 days, a poor outcome (mRS > 2) was observed in 56.9% of patients in the 'after' group vs. 46.3% in the 'before' group, not statistically significant. This association remained statistically insignificant in both univariate and multivariate analyses. CONCLUSION: The personalized BP management during MT resulted in a decrease in BP drops without reaching significance. Furthermore, this study did not indicate any improvement in neurological outcomes at 90 days.