Functional Outcome Following Blood Pressure Drops Within 24 Hours After Successful Mechanical Thrombectomy.

BP drops within 24 hours after successful mechanical thrombectomy were common, occurring in 41% of patients.

• Among 300 patients analyzed, 123 patients (41.0%) had at least 1 BP drop.
• Of those with drops, 77 patients (62.6%) had exactly 1 drop and 46 patients (37.4%) had 2 or more drops.
• BP drops were defined as systolic BP decreases of ≥40 mm Hg occurring within 1 hour during the first 24 hours after groin puncture.
• The study cohort had a median age of 77 years (IQR 65-83), 46.0% female, and median admission NIHSS of 13 points (IQR 7-17).

BP drops were independently associated with worse functional outcome at 3 months as measured by modified Rankin Scale shift analysis.

• In binary analysis (drops vs no drops), the adjusted common OR was 1.66 (95% CI 1.02-2.70).
• In count-based analysis, the adjusted common OR per +1 drop was 1.33 (95% CI 1.05-1.69).
• Functional outcome was assessed using mRS shift analysis at 3 months.
• Associations were evaluated using multivariable ordinal logistic regression.

Patients with BP drops more frequently experienced early neurologic deterioration compared to those without drops.

• Early neurologic deterioration occurred in 22.2% of patients with BP drops versus 13.4% of patients without drops.
• Early neurologic deterioration was defined as an increase of 4 or more points on the NIHSS between admission and 24-hour assessment.
• The adjusted OR for early neurologic deterioration with BP drops was 2.22 (95% CI 1.03-4.78).

BP drops within 24 hours after successful MT were not significantly associated with death at 3 months.

• The adjusted OR for death at 3 months was 1.25 (95% CI 0.66-2.40).
• The confidence interval crossed 1, indicating no statistically significant association.
• Death at 3 months was a prespecified secondary outcome evaluated using multivariable binary logistic regression.

The study was a retrospective observational analysis of patients with successful recanalization after mechanical thrombectomy from two tertiary stroke centers.

• Data were gathered between October 2020 and September 2022 from the German Stroke Registry Endovascular Treatment, a national prospective registry.
• Only patients who reached successful recanalization (mTICI ≥2b) at the end of MT were included.
• High-resolution BP data were obtained using stroke unit monitoring.
• A total of 300 patients were analyzed across 2 tertiary stroke centers.

The optimal target blood pressure during and after mechanical thrombectomy for acute ischemic stroke remains uncertain, with limited evidence on postprocedural BP instability.

• BP drops during MT have been previously associated with worse outcomes.
• Evidence on postprocedural BP instability was characterized as limited at the time of the study.
• The study aimed to address this gap by assessing BP drops specifically within the first 24 hours after MT.