Short-timescale BP variability captured by continuous monitoring in the first 8 hours post-EVT is associated with increased HT risk, whereas intermittent monitoring fails to detect this signal and may miss opportunities for early risk stratification.
Key Findings
Results
Continuous BP monitoring outperformed intermittent monitoring in predicting haemorrhagic transformation in the first 8-hour window post-EVT.
Multivariable model using continuous data yielded an AUC-ROC of 0.62 (95% CI, 0.54–0.71) versus 0.48 (95% CI, 0.37–0.58) for intermittent data.
No parameter from intermittent monitoring showed a statistically significant association with HT.
Continuous BP variability features, particularly maximum, range, and wavelet energies, were significantly associated with HT.
The predictive association was only observed in the first 8-hour window; associations were not observed in later windows.
Results
Haemorrhagic transformation occurred in 29% of patients contributing data to the first 8-hour monitoring window.
Among 455 enrolled patients, 199 contributed data to the first 8-hour window.
HT occurred in 58 of 199 patients (29%) in the first 8-hour window.
Haemorrhagic transformation was assessed on follow-up brain imaging at 24–36 hours post-EVT.
The study was a single-centre prospective cohort including adults with acute ischaemic stroke due to large-vessel occlusion treated with EVT.
Results
Wavelet-based BP variability metrics capturing fluctuations shorter than 32 minutes were specifically associated with haemorrhagic transformation risk.
Wavelet energies capturing less than 32-minute fluctuations were among the continuous BP variability features significantly associated with HT.
Variability metrics processed included mean, maximum, range, SD, coefficient of variation, and wavelet-based coefficient energies.
These short-timescale features are not detectable by standard intermittent arm-cuff measurements.
BP recordings were partitioned into three 8-hour windows, and associations were only significant in the first window.
Methods
The study used simultaneous non-invasive finger-cuff continuous BP and arm-cuff intermittent BP recording over 24 hours post-EVT to compare monitoring modalities.
Non-invasive finger-cuff continuous BP and arm-cuff intermittent BP were recorded simultaneously for 24 hours post-EVT.
BP recordings were partitioned into three 8-hour windows for analysis.
Predictive performance was assessed using AUC-ROC with logistic regression models adjusted for clinical covariates.
The study enrolled 455 patients at a single centre.
Results
BP variability metrics from the first 8-hour post-EVT window, but not later time windows, were associated with haemorrhagic transformation.
Associations between continuous BP variability and HT were not observed in the second or third 8-hour windows.
The first 8-hour post-EVT window was identified as the critical period for BP variability-based risk stratification.
This temporal specificity suggests a window of vulnerability immediately following endovascular therapy.
Matthys A, Bedoucha L, Di Meglio F, Sabben C, Obadia M, Le Cossec C, et al.. (2026). BP-METROLOGY: non-invasive continuous blood pressure monitoring to predict haemorrhagic transformation after endovascular thrombectomy.. European stroke journal. https://doi.org/10.1093/esj/aakag012