Postthrombectomy Systolic Blood Pressure and Clinical Outcome among Patients with Successful Recanalization

BACKGROUND: Optimal blood pressure (BP) management after intraarterial thrombectomy (IAT) has yet to be thoroughly elucidated. We assessed whether maintaining a systolic BP (SBP) of ≤130 mm Hg for 24 h following IAT was associated with better outcomes in patients with successful recanalization. METHODS: Patients presenting with large vessel occlusion within 4 h from symptom onset underwent IAT based on multiphase computed tomography angiography, and those achieving successful recanalization were included in this retrospective analysis. Patients were dichotomized based on a 24-h mean SBP after IAT >130 or ≤130 mm Hg, and functional outcomes were compared at 3 months. At 3 months, 24-h mean SBPs were compared based on recanalization degree, baseline collateral status, stroke mechanism, and occlusion site. RESULTS: The proportion of favorable outcomes at 3 months (modified Rankin Scale [mRS] 0-2) was significantly lower in patients with a mean SBP >130 mm Hg over the 24 h after IAT (40.5 vs. 66.7%, p = 0.02). The distribution of mRS varied significantly among patients with complete recanalization, poor baseline collateral status (pial arterial filling score 0-3), cardioembolic stroke, or middle cerebral artery occlusion, with higher mRS values associated with higher mean SBPs. A mean SBP >130 mm Hg during the 24 h after IAT was associated with worse functional outcomes after multivariable adjustment (OR 2.66; 95% CI 1.11-6.41; p= 0.03). CONCLUSION: Stricter BP control during the 24 h following IAT may improve clinical outcomes in patients with large vessel occlusion who achieved successful recanalization.