Postoperative blood pressure variability exerts an influence on clinical outcome after coil embolization of ruptured intracranial aneurysms

Objective: The present study was conducted to evaluate the effect of postoperative blood pressure (BP) variability on functional outcome in patients after coil embolization of ruptured aneurysms.

Methods: The authors retrospectively reviewed their database of patients undergoing endovascular coiling to treat subarachnoid hemorrhage (SAH) between November 2011 and December 2014. BP values were recorded every 2 hours in the initial 24 hours after endovascular obliteration of ruptured aneurysms. BP variability was determined as standard deviation (SD) and successive variation (SV). Clinical outcome at discharge was assessed by the modified Rankin Scale (mRS) and Glasgow Coma Scale (GCS) Score. BP variability obtained were correlated to patient outcome and analyzed statistically.

Results: Favorable outcomes (mRS 0–1) achieved in 308 (83.7%) of the 368 patients. On univariate logistic analysis, postoperative systolic blood pressure variability (SBPV)-SD, SBPV-SV, diastolic blood pressure variability (DBPV)-SD and DBPV-SV were associated with clinical outcome at discharge. SBPV-SV remained to be an independent predictor for functional recovery (OR, 0.93; 95% CI, 0.88–0.98; P = 0.009) after adjusting for age, postoperative fever, and Hunt–Hess grade by multivariate analysis. Furthermore, patients with higher SBPV had lower GCS grade at discharge (P < 0.001). There was no association between clinical outcome and mean systolic BP (SBP) (P = 0.360) or mean diastolic BP (DBP) (P = 0.105) after coiling.

Conclusion: Postoperative SBPV was a strong predictor of clinical outcome in patients undergoing coil embolization of aneurysms, independent of mean SBP or DBP and seemed to be a potential therapeutic target in aneurysmal SAH.