Blood pressure variability and functional outcome after decompressive hemicraniectomy in malignant middle cerebral artery infarction

Background and purpose: Malignant middle cerebral artery infarction (MMI) is a severe condition with a high mortality rate. While decompressive hemicraniectomy has been demonstrated to reduce mortality, there is limited knowledge regarding blood pressure (BP) management following the surgery. This study aimed to investigate whether early blood pressure variability after surgery is associated with functional outcomes.

Methods: This study was a retrospective cohort analysis of patients with MMI who underwent decompressive hemicraniectomy. We calculated BP variability (BPV) by measuring BP hourly over a 72-h period following surgery. We investigated the association between BPV parameters and functional outcomes at 3-month. Additionally, we analyzed which specific time intervals within the 72 h post-surgery BPV were associated with functional outcomes.

Results: A total of 110 patients were eligible for analysis. The mean age was 63.1 ± 13.1 years, and 57 (51.8%) were men. Among the systolic BPV parameters, the coefficient of variance showed a significant association with functional outcomes at 3-month (adjusted odds ratio [AOR]: 0.82, 95% CI: 0.69-0.95), and this association remained significant after adjusting for the antihypertensive agents use (AOR: 0.82, 95% CI: 0.70-0.95). In contrast, diastolic BPV parameters did not show a significant association with functional outcomes. Systolic BPV during the 0- to 24-h period of the 72-h observation was significantly associated with functional outcomes (AOR: 0.87, 95% CI: 0.76-0.98).

Conclusion: Our study identified a significant association between systolic BPV and 3-month functional outcomes in MMI patients who underwent decompressive hemicraniectomy. This association persisted regardless of the use of antihypertensive agents, particularly during the hyperacute phase within the first 24 h post-surgery.