Antihypertensive Drugs after Thrombectomy in Acute Ischemic Stroke with Poor Collateral Are Associated with Unfavorable Outcome.

Introduction: The impact of antihypertensive drugs on functional outcome in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT) remains controversial and may vary with collateral status (CS). We aimed to investigate the joint effect of CS and antihypertensive drugs on functional outcome in patients with AIS.

Methods: We retrospectively analyzed anterior circulation large-vessel occlusion AIS patients who underwent EVT in our hospital between January 2018 and December 2022. The patients were dichotomized to good CS, reflected by hypoperfusion index ratio (HIR) ≤0.4, and poor CS, reflected by HIR >0.4. Functional outcome was assessed using modified Rankin Scale (90d mRS). The primary outcome was defined as the 90d mRS > 2. The association between antihypertensive drugs within 48 h after EVT and functional outcome was evaluated. Furthermore, the interaction between HIR and antihypertensive drugs was measured.

Results: A total of 372 patients were included. The proportion of patients receiving antihypertensive drugs was comparable between the good CS and poor CS group (51% vs. 56%, p = 0.285). Antihypertensive drugs were significantly associated with higher odds ratio (OR) of unfavorable outcome {OR 3.83 (95% confidence interval [CI], 2.12-6.90); p < 0.001} in poor CS group. No correlation was found in good CS group (p = 0.159). The interaction between antihypertensive drugs and baseline CS was statistically significant (P_interaction = 0.040, adjusted P_interaction = 0.029).

Conclusion: The association between antihypertensive drugs and functional outcome varied based on the CS. These findings suggest that antihypertensive drugs should be used with caution in AIS patients with poor CS after EVT.