Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients

Objective Permissive hypertension may benefit patients with non-recanalized large vessel occlusion (nrLVO) post mechanical thrombectomy (MT) by maintaining brain perfusion. Data evaluating the impact of post-MT blood pressure (BP) levels on outcomes in nrLVO patients are scarce. We investigated the association of the post-MT BP course with safety and efficacy outcomes in nrLVO. Methods Hourly systolic BP (SBP) and diastolic BP (DBP) values were prospectively recorded for 24hours following MT in consecutive nrLVO patients. Maximum, minimum, and mean BP levels were documented. Three-month functional independence (FI) was defined as modified Rankin Scale (mRS) scores of 0-2. Results A total of 88 nrLVO patients were evaluated post MT. Patients with FI had lower maximum SBP (16019mmHg vs 179 +/- 23mmHg; P=0.001) and higher minimum SBP levels (119 +/- 12mmHg vs 108 +/- 25mmHg; P=0.008). Maximum SBP (183 +/- 20mmHg vs 169 +/- 23mmHg; P=0.008) and DBP levels (105 +/- 20mmHg vs 89 +/- 18mmHg; P=0.001) were higher in patients who died at 3 months while minimum SBP values were lower (102 +/- 28mmHg vs 115 +/- 16mmHg; P=0.007). On multivariable analyses, both maximum SBP (OR per 10mmHg increase: 0.55, 95%CI 0.39 to 0.79; P=0.001) and minimum SBP (OR per 10mmHg increase: 1.64, 95%CI 1.04 to 2.60; P=0.033) levels were independently associated with the odds of FI. Maximum DBP (OR per 10mmHg increase: 1.61; 95%CI 1.10 to 2.36; P=0.014) and minimum SBP (OR per 10mmHg increase: 0.65, 95%CI 0.47 to 0.90; P=0.009) values were independent predictors of 3-month mortality. Conclusions Our study demonstrates that wide BP excursions from the mean during the first 24hours post MT are associated with worse outcomes in patients with nrLVO.