To investigate the association between blood pressure (BP) management within the first 24 hours after endovascular thrombectomy (EVT) and clinical outcomes in acute ischemic stroke (AIS) patients.

BP control after EVT strongly correlates with the clinical outcomes in AIS patients. Current guidelines recommend absolute BP control targets while emerging study results suggest a drastic BP reduction in the acute phase might cause poor outcomes. The acute management of BP after EVT remains uncertain.

A retrospective study was conducted on a consecutive sample of patients from 2016 to 2019 who underwent EVT at a tertiary center. The hourly BP data were collected for the first 24 hours. BP variability was expressed as the interquartile range (IQR) of the BP distribution. BP level was represented by the median. The outcome of interest was the poor functional outcome at discharge, which was defined as the modified Rankin Scale of ?4.

Of the 95 enrolled subjects, 58(61.1%) had poor functional outcomes at discharge and 8 out of them (8.4%) died. After adjustment for baseline clinical covariates and illness severity, a 10mmHg increment in IQR of systolic BP (SBP) during the first 24 hours post-EVT was independently associated with poor functional outcomes (odds ratio [OR] 2.32, 95% CI 1.04-5.15, p=0.039). Within the range of 65-120mmHg, a 10mmHg increment in the median of mean arterial pressure (MAP) was associated with a lower risk of poor functional outcomes (odds ratio [OR] 0.57, 95% CI 0.35-0.92, p=0.021). The absolute SBP control targets, SBP<140 or 160 or 180mmHg, were not associated with outcomes at discharge.

In AIS patients treated with EVT, a higher SBP variability in the first 24 hours is associated with unfavorable discharge outcomes. However, within the target BP level, higher MAP in the acute phase is a predictor of good functional outcomes after EVT.