Mid-term systolic BP variability beyond 24 h after successful recanalization predicts poor outcomes following...

Although intensive blood pressure (BP) lowering after mechanical thrombectomy (MT) may adversely affect outcomes, the prognostic significance of post-recanalization BP variability remains unclear. This study aimed to evaluate the association between systolic blood pressure (SBP) variability after successful recanalization and 90-day functional outcomes following MT. Among 342 consecutive patients who underwent MT between May 2014 and June 2025, 280 patients who achieved successful recanalization were included in this retrospective analysis. SBP was recorded from immediately after recanalization up to 72 h thereafter. BP variability indices, including variability independent of the mean (VIM), time rate, and coefficient of variation, were calculated. The primary outcome was defined as a modified Rankin Scale (mRS) score of 4-6 at 90 days. Associations between SBP variability and outcomes were assessed using multivariable logistic regression models. Of the 280 patients, 104 (37.1%) experienced poor functional outcomes. Higher SBP variability was significantly associated with unfavorable outcomes. In time-segmented analyses, only SBP variability during the 24-72-h period remained significantly associated with poor outcomes (aOR per 10-unit increase in VIM [VIM/10], 1.89; 95% CI, 1.20-3.06, p = 0.005). Sensitivity analyses excluding patients who received antihypertensive therapy during 24-72 h and those with symptomatic intracranial hemorrhage confirmed the robustness of the association between 24-72 h VIM and poor outcomes (aOR VIM/10, 1.94; 95% CI, 1.26-3.11, p = 0.003). In conclusion, these findings highlight the clinical importance of stabilizing BP beyond the first 24 h after recanalization.