E-084 Nicardipine versus clevidipine for post mechanical thrombectomy blood pressure management in patients with ischemic stroke due to isolated middle cerebral artery occlusion

Objective Intensive blood pressure (BP) management after mechanical thrombectomy (MT) may be beneficial in patients with acute anterior circulation (AC) Ischemic stroke (IS) due to large vessel occlusion (LVO). We sought to evaluate the efficacy of Nicardepine (NCR) vs. Clevidipine (CLV) in IS patients with LVO who underwent successful MT. Methods With IRB approval, we retrospectively collected data on consecutive patients with isolated MCA M1 occlusion who underwent successful MT (TICI score of 2B or 3). Patient demographics, baseline characteristics, time efficiencies, procedural data, incidence of hemorrhagic transformation (HI) and symptomatic ICH per ECASS II criteria on 24H head CT, and clinical outcomes were recorded. We also recorded duration from recanalization to optimal BP control (ROBP), IV drip utilized (NCR vs. CLV), number of SBP excursions, and total duration of time outside the target SBP in first 24H. Results We identified 111 patients between 2017 and 2020, 57 patients required a drip (43 NCR, 14 CLV), and 54 patients were managed with prn medications. Median NIHSS was higher in the drip group (18, IQR 13-21) vs. 15.5 (IQR 9-20), p value= 0.03. There was no significant difference in the rate of good clinical outcome defined as mRs of 0-2 or return to baseline (47.4 vs 61.1%, p value=0.18); rate of any HI (29.8% vs. 27.8%, p value=0.84) and sICH(5.3% vs 0%, p value=0.24) between the two groups ( drip vs. no drip). When comparing the NCR to CLV groups, median ROBP was significantly shorter in the CLV group, 5min (IQR 0.75-7) vs. 17min (IQR 6-35), p value= 0.003; and total duration of time outside the pre-specified BP range was 37.5 min (IQR 19-120) vs. 118 min (57-227) consecutively, p value=0.045. HT rates (14.3% vs. 34.9%, p value=0.19), sICH rates (0 vs. 7%, p value=0.57), and rate of good clinical outcome (64.3% vs. 41.9%, p value=0.22) were similar between the two groups (CLV vs. NCR). In a Multivariate analysis, after adjusting for age, gender, IV tPA administration, drip used and time out of range; NIHSS (OR 0.8, CI 0.70-0.91, p=0.0008) and ROBP (OR=1.05, CI 1.0-1.1, p value=0.032) were independent predictors of good clinical outcome. Conclusion CLV achieved faster ROBP time and better BP control after MT. Further prospective studies are needed. Disclosures M. Oliver: None. J. Shawver: None. H. Salahuddin: None. S. Desai: None. S. Zaidi: None. M. Jumaa: None.