The Impact of Blood Pressure Management Strategies on Outcome in Acute Ischemic Stroke Patients After Successful Mechanical Thrombectomy

Background: CThere is variability and no general consensus in how blood pressure should be managed after successful mechanical thrombectomy (MT) for large vessel ischemic stroke. We examined whether exceeding systolic blood pressure (SBP) targets in patients during the first 24 hours after successful MT led to worse outcomes. Methods: We retrospectively studied a consecutive sample of adult patients who underwent MT. We collected SBP data from the first 24 hours after MT and categorized them into 3 groups based on instances of SBP exceeding 140 mmHg, 160 mmHg, or 180 mmHg. Primary and secondary outcomes were patient’s modified Rankin Scale (mRS) status at discharge and 90-day follow-up and incidence of symptomatic intracranial hemorrhage (sICH), malignant cerebral edema, hemicraniectomy, mortality within 90 days, and discharge disposition. Results: A total of 117 patients were included (mean age 66 ± 13 years; 53% female). Patients with at least one instance of SBP ≥ 180 mmHg were found to be significantly associated with poor functional outcomes at discharge (adjusted OR 5.83; 95%CI, 1.41-32.9; P = 0.025), but not at 90-day follow-up. Patient’s with instances of SBP > 160 mmHg had independently increased odds of developing malignant cerebral edema (adjusted OR 17.07; 95%CI, 2.56 – 174.4; P = 0.01) and showed a trend towards increased odds of sICH (adjusted OR 4.42; 95%CI, 1.03 – 21.2; P = 0.0503). Conclusions: Results suggest that individual instances of SBP elevation alone after successful MT, rather than necessarily prolonged increased blood pressure as reflected in mean or median BP values, may significantly impact clinical outcomes after successful MT.