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Background and Purpose: Optimal blood pressure (BP) management in the acute phase of ischemic stroke remains an unresolved issue. It is uncertain whether guidelines for BP management during and after intravenous alteplase can be extrapolated to endovascular treatment (EVT) for stroke due to large artery occlusion in the anterior circulation. We evaluated the associations between systolic BP (SBP) in the first 6 hours following EVT and functional outcome as well as symptomatic intracranial hemorrhage., Methods: Patients of 8 MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry centers, with available data on SBP in the 6 hours following EVT, were analyzed. We evaluated maximum, minimum, and mean SBP. Study outcomes were functional outcome (modified Rankin Scale) at 90 days and symptomatic intracranial hemorrhage. We used multivariable ordinal and binary regression analysis to adjust for important prognostic factors and studied possible effect modification by successful reperfusion., Results: Post-EVT SBP data were available for 1161/1796 patients. Higher maximum SBP (per 10 mm Hg increments) was associated with worse functional outcome (adjusted common odds ratio, 0.93 [95% CI, 0.88–0.98]) and a higher rate of symptomatic intracranial hemorrhage (adjusted odds ratio, 1.17 [95% CI, 1.02–1.36]). The association between minimum SBP and functional outcome was nonlinear with an inflection point at 124 mm Hg. Minimum SBP lower and higher than the inflection point were associated with worse functional outcomes (adjusted common odds ratio, 0.85 per 10 mm Hg decrements [95% CI, 0.76–0.95] and adjusted common odds ratio, 0.81 per 10 mm Hg increments [95% CI, 0.71–0.92]). No association between mean SBP and functional outcome was observed. Successful reperfusion did not modify the relation of SBP with any of the outcomes., Conclusions: Maximum SBP in the first 6 hours following EVT is positively associated with worse functional outcome and an increased risk of symptomatic intracranial hemorrhage. Both lower and higher minimum SBP are associated with worse outcomes. A randomized trial to evaluate whether modifying post-intervention SBP results in better outcomes after EVT for ischemic stroke seems justified.

Objective: To evaluate the role of blood pressure (BP) as mediator of the effect of conscious sedation (CS) compared to local anesthesia (LA) on functional outcome after endovascular treatment (EVT)., Methods: Patients treated in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry centers with CS or LA as preferred anesthetic approach during EVT for ischemic stroke were analyzed. First, we evaluated the effect of CS on area under the threshold (AUT), relative difference between baseline and lowest procedural mean arterial pressure (∆LMAP), and procedural BP trend, compared to LA. Second, we assessed the association between BP and functional outcome (modified Rankin Scale [mRS]) with multivariable regression. Lastly, we evaluated whether BP explained the effect of CS on mRS., Results: In 440 patients with available BP data, patients treated under CS (n = 262) had larger AUTs (median 228 vs 23 mm Hg*min), larger ∆LMAP (median 16% vs 6%), and a more negative BP trend (-0.22 vs -0.08 mm Hg/min) compared to LA (n = 178). Larger ∆LMAP and AUTs were associated with worse mRS (adjusted common odds ratio [acOR] per 10% drop 0.87, 95% confidence interval [CI] 0.78-0.97, and acOR per 300 mm Hg*min 0.89, 95% CI 0.82-0.97). Patients treated under CS had worse mRS compared to LA (acOR 0.59, 95% CI 0.40-0.87) and this association remained when adjusting for ∆LMAP and AUT (acOR 0.62, 95% CI 0.42-0.92)., Conclusions: Large BP drops are associated with worse functional outcome. However, BP drops do not explain the worse outcomes in the CS group., (Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

This study demonstrates a diurnal variation in FVC measured with home spirometry in patients with f-ILD, with a higher FVC in the morning than in the afternoon http://bit.ly/37SQtBK., Competing Interests: Conflict of interest: C.C. Moor reports grants and support from Boehringer Ingelheim outside the submitted work. Conflict of interest: C.A.L. van den Berg has nothing to disclose. Conflict of interest: L.S. Visser has nothing to disclose. Conflict of interest: J.G.J.V. Aerts has nothing to disclose. Conflict of interest: V. Cottin reports personal fees and nonfinancial support for advisory boards, lectures and travel to medical meetings from Actelion; grants, personal fees and nonfinancial support for consultancy, lectures and travel to medical meetings from Boehringer Ingelheim; personal fees for advisory boards and membership of a data safety monitoring boards (DSMB) from Bayer/MSD; personal fees for advisory boards and lectures from Novartis; personal fees and nonfinancial support for consultancy, lectures and travel to medical meetings from Roche; personal fees for lectures from Sanofi, personal fees for chairing as DSMB and membership of a steering committee from Promedior; personal fees for membership of a DSMB from Celgene; personal fees for advisory boards and cochairing a DSMB from Galapagos; and personal fees for membership of a DSMB from Galecto, all outside the submitted work. Conflict of interest: M.S. Wijsenbeek reports grants and other support from Hoffman-la Roche and Boehringer Ingelheim, and other support from Galapagos, all paid to her institution and all outside the submitted work., (Copyright ©ERS 2020.)