Abstract Body: Background: Endovascular thrombectomy (EVT) has improved both short-term and long-term outcomes for acute ischemic stroke (AIS) patients caused by large vessel occlusion (LVO). However, the relationships between blood pressure (BP) after EVT and outcomes had not been determined. As BP is dynamically changes, the present study investigated the effects of BP trajectories after EVT on the outcomes in AIS patients with LVO using Group-Based Trajectory Modeling (GBTM).
Methods: This was a retrospective, single-center observational study. The AIS patients with LVO in the anterior circulation within 24 hours of symptom onset, baseline modified Rankin Scale (mRS) score ≤2, and Alberta Stroke Program Early CT Score (ASPECTS) score ≥6 were included. BP was monitored frequently post-EVT, and PP was calculated as the difference between systolic and diastolic BP. GBTM identified distinct PP trajectories over 0-6 hours and 0-48 hours post-EVT. Short-term outcomes included hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (SICH), while long-term outcomes included National Institutes of Health Stroke Scale (NIHSS) at 7 days and mRS score at 3 months.
Results: Out of 506 screened patients, 313 were included in the final analysis. GBTM identified three distinct PP trajectories within the first 6 and 48 hours post-EVT. The 0–6 hour PP trajectory was significantly correlated with HT (OR=1.81, 95% CI 1.28-2.54), which remained significant after adjustment (OR = 1.72, 95% CI 1.17-2.53). An elevated PP trajectory was associated with a 3.04-fold higher risk of HT compared to the normal trajectory. Mediation analysis indicated the 7-day NIHSS score mediated 88.92% of the association between severe elevated PP trajectory and mRS.
Conclusion: Severely elevated PP trajectory post-EVT is independently associated with poor short-term outcomes in AIS patients with LVO. Effective management of PP in the acute phase post-EVT may be crucial for improving prognosis of AIS patients with LVO.