Supplementary Material for: Antihypertensive drugs after Thrombectomy in Acute Ischemic Stroke with Poor Collateral are Associated with Unfavorable Outcome

OBJECTIVE: The impact of antihypertensive drugs on functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT) remains controversial and may vary with collateral status (CS). We aim to investigate the joint effect of CS and antihypertensive drugs on functional outcome in patients with AIS.
METHODS: We retrospectively analyzed anterior circulation large-vessel occlusion (LVO) AIS patients who underwent EVT in our hospital between January 2018 and December 2022. The patients were dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) ≤ 0.4, and poor CS, reflected by HIR > 0.4. Functional outcome was assessed using modified Rankin Scale (90d-mRS). The primary outcome was defined as the 90d-mRS > 2. The association between antihypertensive drugs within 48 hours after EVT and functional outcome was evaluated. Furthermore, the interaction between HIR and antihypertensive drugs was measured.
RESULTS: A total of 372 patients were included. The proportion of patients receiving antihypertensive drugs was comparable between the good CS and poor CS group (51% vs. 56%, P = 0.285). Antihypertensive drugs were significantly associated with higher odds ratio (OR) of unfavorable outcome (OR 3.83 [95% confidence interval (CI), 2.12-6.90]; P < 0.001) in poor CS group. No correlation was found in good CS group (P = 0.159). The interaction between antihypertensive drugs and baseline CS was statistically significant (Pinteraction = 0.040, adjusted Pinteraction = 0.029).
CONCLUSION: The association between antihypertensive drugs and functional outcome varied based on the CS. These findings suggest that antihypertensive drugs should be used with caution in AIS patients with poor CS after EVT.

研究背景：血管内取栓术（endovascular thrombectomy, EVT）后，抗高血压药物对急性缺血性脑卒中（acute ischemic stroke, AIS）患者功能预后的影响尚存争议，且可能随侧支循环状态（collateral status, CS）的不同而存在差异。本研究旨在探讨侧支循环状态与抗高血压药物对急性缺血性脑卒中患者功能预后的联合影响。
方法：本研究回顾性分析了2018年1月至2022年12月于本院接受血管内取栓术的前循环大血管闭塞（anterior circulation large-vessel occlusion, LVO）型急性缺血性脑卒中患者。以低灌注指数比值（hypoperfusion index ratio, HIR）≤0.4定义侧支循环状态良好组，以HIR＞0.4定义侧支循环状态不良组。采用改良Rankin量表（90天mRS, 90d-mRS）评估患者的功能预后，主要预后终点定义为90天mRS评分＞2分。本研究评估了血管内取栓术后48小时内使用抗高血压药物与功能预后之间的关联，并进一步分析了低灌注指数比值与抗高血压药物之间的交互作用。
结果：本研究共纳入372例患者。侧支循环良好组与不良组中接受抗高血压药物治疗的患者比例无显著差异（51% vs. 56%，P=0.285）。在侧支循环不良组中，抗高血压药物治疗与不良功能预后的比值比（odds ratio, OR）显著升高（OR=3.83，95%置信区间（confidence interval, CI）：2.12~6.90；P＜0.001）；而在侧支循环良好组中未发现此类关联（P=0.159）。抗高血压药物与基线侧支循环状态之间的交互作用具有统计学意义（交互P值=0.040，校正后交互P值=0.029）。
结论：抗高血压药物与功能预后之间的关联因侧支循环状态不同而存在差异。本研究结果提示，对于血管内取栓术后侧支循环状态不良的急性缺血性脑卒中患者，应谨慎使用抗高血压药物。