Association Between Early Spontaneous Post-Thrombectomy Blood Pressure Reduction and Clinical Outcomes in Large Vessel Occlusion Stroke

Objective

To investigate the association between early spontaneous blood pressure (BP) reductions after thrombectomy, without pharmacological intervention, and clinical outcomes in patients with acute anterior circulation large vessel occlusion (LVO) stroke.

Methods

Consecutive patients with anterior circulation LVO stroke who underwent thrombectomy at a single center between January 2021 and June 2024 were retrospectively analyzed. Blood pressure (BP) measurements were obtained upon arrival at the angiography suite and within half an hour post-thrombectomy, along with the reductions in BP before and after the thrombectomy (ΔBP). Multivariate logistic regression was used to identify independent predictors of favorable outcome (90-day modified Rankin Scale score of 0–2), while receiver operating characteristic (ROC) curves evaluated predictive performance.

Results

Among 484 patients, 41.5% achieved a favorable outcome. Greater systolic ΔBP (ΔSBP) reduction (per 10 mmHg increase) (adjusted odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06–1.18) and nadir SBP within half an hour post-thrombectomy (per 10 mmHg increase) (adjusted OR, 0.98; 95% CI, 0.97–0.99) were independently associated with favorable outcome. In addition, National Institutes of Health Stroke Scale scores, collateral scores, successful recanalization, hemorrhagic transformation, and symptomatic intracranial hemorrhage were also associated with the outcome (P < 0.05). ΔSBP and nadir SBP within half an hour post-thrombectomy predicted favorable outcomes with individual AUCs of 0.81 and 0.76, respectively, and a combined AUC of 0.88 (sensitivity 82.4%, specificity 85.7%, PPV 78.9%).

Conclusion

Early spontaneous post-thrombectomy SBP reduction independently predicts favorable outcome in LVO, with improved predictive accuracy when combined with nadir SBP early post-thrombectomy.