Blood Pressure Trajectory Groups and Outcome After Endovascular Thrombectomy: A Multicenter Study

Area of Science:

• Neurology
• Cardiovascular Medicine
• Radiology

Background:

• Elevated blood pressure post-endovascular thrombectomy (EVT) correlates with poor outcomes in ischemic stroke.
• Optimal hemodynamic management after EVT is not well-defined.
• Acute phase blood pressure patterns in ischemic stroke require further characterization.

Purpose of the Study:

• To identify distinct patient subgroups based on systolic blood pressure (SBP) trajectories after EVT.
• To investigate the association between these SBP trajectories and radiographic and functional outcomes.

Main Methods:

• A multicenter retrospective cohort study of patients with anterior circulation large-vessel occlusion ischemic stroke undergoing EVT.
• Collection of time-stamped blood pressure data for 72 hours post-thrombectomy.
• Latent variable mixture modeling to define five distinct SBP trajectories.

Main Results:

• Five SBP trajectories identified: low (18%), moderate (37%), moderate-to-high (20%), high-to-moderate (18%), and high (6%).
• SBP trajectory independently associated with 90-day functional outcome (P<0.0001).
• High and high-to-moderate SBP trajectories linked to unfavorable outcomes (aOR 3.5 and 2.2, respectively) and symptomatic intracranial hemorrhage (aOR 1.82).

Conclusions:

• Distinct SBP trajectories exist in the 72 hours post-EVT for acute ischemic stroke.
• These trajectories significantly correlate with functional outcomes.
• Findings may inform patient selection for future blood pressure modulation trials.