ABSTRACT Objectives To investigate the impact of early postoperative blood pressure variability (BPV) on 90‐day functional outcomes in patients with acute ischemic stroke due to large vessel occlusion (AIS‐LVO) undergoing mechanical thrombectomy, and to assess its interaction with pre‐existing hypertension. Methods This retrospective cohort study included 144 AIS‐LVO patients treated with mechanical thrombectomy between January 2022 and September 2024. Systolic blood pressure was recorded hourly during the first 24 h post‐procedure, and BPV was calculated as the standard deviation of systolic BP. Patients were divided into low and high BPV groups according to the median BPV value. Functional outcome at 90 days was assessed using the modified Rankin Scale (mRS), with 0–2 defined as favorable. Subgroup analyses were performed according to hypertension status. Results Patients in the high BPV group had significantly higher baseline NIHSS and worse 90‐day mRS scores ( p = 0.021 and p = 0.007, respectively). Favorable outcomes were achieved in 29.5% of high BPV patients compared with 60% of low BPV patients ( p = 0.007). ROC analysis showed moderate predictive ability of BPV for favorable outcomes ( AUC = 0.743, 95% CI : 0.662–0.840). The detrimental effect of elevated BPV was more pronounced among patients with pre‐existing hypertension. Conclusions Elevated early postoperative BPV is independently associated with worse 90‐day functional outcomes in AIS‐LVO patients undergoing thrombectomy, particularly in those with hypertension. These findings suggest that maintaining stable blood pressure during the early postoperative period may help optimize recovery in this high‐risk population.
Liu et al. (2026) studied this question.