Trajectory Groups of 24-h Systolic Blood Pressure After Mechanical Thrombectomy and Outcomes

Elevated blood pressure (BP) following mechanical thrombectomy (MT) has been linked to poorer outcomes, but optimal BP management remains uncertain. This study sought to identify distinct systolic BP (SBP) trajectories in patients after MT and assess their impact on clinical outcomes. We prospectively enrolled 544 acute ischemic stroke patients with large vessel occlusion who underwent MT between July 2017 and December 2024. Hourly SBP measurements were recorded for 24 h post-procedure. Using latent variable mixture modeling, we classified patients into five trajectory groups: low (11.8%), normal (27.4%), relatively stabilized (40.4%), U-shaped (17.5%), and high BP (2.9%). Functional outcomes were assessed at 3 months using the modified Rankin Scale (mRS), with poor outcome defined as mRS >2. Secondary outcomes included all-cause mortality (mRS = 6) and symptomatic intracranial hemorrhage (sICH). After adjusting for confounders, SBP trajectory groups were independently associated with poor functional outcome (p for trend <0.001) and mortality (p for trend = 0.004), but not with sICH. These findings suggest that post-MT SBP trajectories may help stratify patients at higher risk of disability or death. Higher SBP level in patients after MT may be correlated with poor prognosis of the patients.