Abstract Background and aims Post mechanical thrombectomy (MT) blood pressure (BP) control target is yet to be established. Current AHA guideline recommends maintaining BP180/105 mmHg during and after MT for the first 24 hours, like thrombolysis to prevent haemorrhagic transformation. This study was to explore the effect of BP on stroke outcome in patients with successful recanalization. Methods Data was obtained from the prospective MT registry from a major London comprehensive stroke centre. Baseline characteristics, systolic BP (SBP) immediately post MT, mean SBP during the first 24 hours and functional outcome (Modified Rankin Score (mRS) at 90 days) were recorded. Good functional outcomes (mRS 3) were compared across different SBP thresholds: 110mmHg, 120mmHg, 140mmHg and 160mmHg. Results Between January 2022 and April 2025, 281 patients were included after excluding cases of unsuccessful reperfusion (modified Treatment in Cerebral Ischemia, mTICI ≤2a), posterior circulation stroke and missing data. Significant differences in functional outcomes were observed between SBP 140 vs ≥140mmHg, and 160 vs ≥160mmHg, both SBP immediately after MT and the mean 24hr SBP. After adjusting for risk factors, diabetes (p=0.004), atrial fibrillation (AF) (p=0.033) and SBP≥160 mmHg immediately after MT (p=0.007, 95% CI (-0.380, -0.062)) were independent predictors for poor prognosis. There were no significant differences in haemorrhage transformation and symptomatic intracranial haemorrhage. Conclusions Our data suggests tighter BP control (targeting SBP160mmHg) immediately after MT may be beneficial in patients achieved successful thrombectomy, especially in patients with diabetes and AF. The benefit of BP control was independent of haemorrhagic transformation. Conflict of interest Dr.Liqun Zhang: nothing to disclose
Ghatala et al. (Fri,) studied this question.