Time-Dependent Relationship between Blood Pressure Trajectory and Functional Outcomes after Endovascular Thrombectomy

Area of Science:

• Neurology
• Cardiology
• Interventional Radiology

Background:

• The prognostic value of spontaneous systolic blood pressure (SBP) reduction after endovascular thrombectomy (EVT) for acute ischemic stroke is not well understood.
• The optimal timing for antihypertensive therapy initiation in patients with elevated SBP post-reperfusion remains uncertain.

Purpose of the Study:

• To investigate the prognostic significance of SBP reduction at different time points following EVT.
• To determine the optimal SBP threshold and timing for predicting functional outcomes after EVT.

Main Methods:

• Retrospective analysis of 349 patients undergoing EVT for large vessel occlusion stroke (2015-2024).
• SBP was monitored from emergency department arrival through 24 hours post-procedure.
• Patients were categorized based on SBP < 140 mm Hg immediately post-recanalization or within 1 hour post-EVT (after stabilization).

Main Results:

• 45.0% of patients achieved SBP < 140 mm Hg immediately post-recanalization.
• SBP < 140 mm Hg immediately post-recanalization was not significantly associated with good functional outcomes.
• SBP < 140 mm Hg measured after stabilization (within 1 hour post-EVT) was independently associated with good functional outcomes (aOR 6.92, P < 0.001).

Conclusions:

• Achieving SBP < 140 mm Hg within 1 hour post-EVT (after stabilization) is a significant predictor of good functional outcomes.
• The timing of SBP measurement (after stabilization vs. immediately post-recanalization) is crucial for prognostic assessment.
• Use of BP-lowering agents immediately after recanalization did not independently predict outcomes.