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

The prognostic significance of spontaneous systolic blood pressure (SBP) reduction following endovascular thrombectomy (EVT) remains unclear, especially according to the timing of measurement. The optimal timing for initiating antihypertensive therapy in patients with elevated SBP after reperfusion is also uncertain.

We retrospectively analyzed 349 patients with acute ischemic stroke due to large vessel occlusion who underwent EVT between 2015 and 2024. SBP was recorded from the time of arrival at the emergency department through 24 h post-procedure. Patients were classified on the basis of whether their SBP dropped below 140 mm Hg immediately after recanalization or upon admission to the intensive care unit within 1 h after EVT (after stabilization). Use of BP-lowering agents administered immediately after recanalization was also recorded and analyzed. The primary outcome was good functional status (modified Rankin scale score 0-2) at 3 months.

Among the 349 patients (mean age: 71.4 ± 10.4 years; 56.2% male), 45.0% had a mean SBP of less than 140 mm Hg immediately following recanalization. While SBP < 140 mm Hg immediately following recanalization did not show a significant association with the primary outcome, SBP < 140 mm Hg measured after stabilization (within 1 h post-EVT) was independently associated with good outcomes (adjusted odds ratio 6.92, 95% confidence interval 2.47-19.43, P < 0.001). The use of BP-lowering agents among those with elevated SBP immediately after recanalization did not show an independent association with the primary outcome.

SBP < 140 mm Hg after stabilization following EVT, rather than immediately after recanalization, was associated with good functional outcomes, regardless of the use of BP-lowering agents immediately after recanalization.