Impact of spontaneous systolic blood pressure change from admission to postthrombectomy on outcomes in anterior large vessel occlusion patients

BACKGROUND: Among large vessel occlusion (LVO) patients managed with mechanical thrombectomy (MT), the clinical implications of spontaneous blood pressure fluctuations on clinical outcomes remain incompletely understood. METHODS: We screened LVO patients with successful recanalization from two cohorts. Using a 10 mmHg cutoff, patients were classified into systolic blood pressure (SBP) increase, decrease, and stable groups. The primary efficacy outcome was 90-day functional independence with a modified Rankin Scale (mRS) score ≤ 2. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). The associations between SBP changes and clinical outcomes were assessed using a generalized linear model. We performed three sensitivity analyses: inverse probability of treatment weighting, separate analyses for each cohort, and reclassification using a 5 mmHg SBP cutoff. RESULTS: Of 580 patients, 165 (28.4%) had stable SBP, 331 (57.1%) decreased, and 84 (14.5%) increased. Compared with the stable group, decreased SBP group was significantly less likely to achieve functional independence (40.8% vs. 58.2%; P = 0.019), had higher mRS scores at 90 days (3.0 vs. 2.0, P = 0.009), and a numerically increased sICH rate (9.1% vs. 6.1%). Though the increased SBP group had a significantly higher proportion of all-cause mortality rate (25.0% vs. 12.7%, P = 0.018) and a numerically higher sICH rate (13.6% vs. 6.1%, P = 0.085), it showed a functional outcome similar to that of the stable group. These results were robust across all sensitivity analyses. CONCLUSIONS: Among LVO patients with successful recanalization after MT, an immediate SBP decrease following MT may appear to be related to worse clinical outcomes.