Association of intensive blood pressure lowering after endovascular thrombectomy with outcomes according to contrast staining ASPECTS

Background Intensive blood pressure (BP) lowering after successful endovascular thrombectomy (EVT) failed to improve functional outcomes, but its association with the extent of blood-brain barrier disruption remains unclear. We investigated whether Contrast Staining-Alberta Stroke Programme Early CT Score (CS-ASPECTS) and contrast staining (CS) after EVT modify the outcomes of post-EVT BP management strategy. Methods This post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure trial included acute stroke patients who achieved successful EVT and underwent follow-up brain CT within 3 hours of randomisation to intensive (systolic BP <140 mm Hg) or conventional (140–180 mm Hg) BP management. Subgroup analyses were conducted based on CS status and CS-ASPECTS. Results Among 174 patients (mean age 72.8±12.1 years, 38.5% women), CS was present in 123 (70.7%). CS was associated with a higher rate of any intracranial haemorrhage (ICH) but not with functional outcome. CS-ASPECTS 0–6 was associated with a higher risk of symptomatic ICH and worse functional outcome compared with CS-ASPECTS 7–10. Among patients with CS-ASPECTS 7–10, intensive BP lowering was associated with a lower likelihood of functional independence (adjusted OR 0.37, 95% CI 0.15 to 0.87), whereas no significant association was observed in patients with CS-ASPECTS 0–6 (adjusted OR 1.29, 95% CI 0.20 to 9.09) (P for interaction=0.044). There was no significant heterogeneity between BP management strategy and CS-ASPECTS for symptomatic intracerebral haemorrhage or mortality. Conclusions CS-ASPECTS, but not CS alone, was associated with functional outcome and identified heterogeneity in the association between post-EVT BP lowering and functional independence. These exploratory findings warrant prospective validation before clinical application. Trial registration number NCT04205305 .