Impact of blood pressure levels and variability after successful revascularization on the prognosis in ICAS-LVOS patients

TL;DR

This study shows that maintaining stable and lower blood pressure after stroke treatment improves recovery outcomes in patients with intracranial atherosclerosis-related large vessel occlusion.

Contribution

The study identifies specific blood pressure metrics linked to neurological outcomes after revascularization in ICAS-LVOS patients.

Findings

Higher systolic blood pressure levels and variability are associated with reduced early recovery in ICAS-LVOS patients.

Greater blood pressure variability increases the risk of neurological deterioration after stroke treatment.

Stroke location modifies the effect of blood pressure variability on recovery outcomes.

Abstract

Optimal blood pressure management after endovascular treatment (EVT) for intracranial atherosclerosis-related large vessel occlusion stroke (ICAS-LVOS) remains uncertain. This study evaluated the impact of systolic blood pressure (SBP) and blood pressure variability (BPV) on early outcomes following successful recanalization.

We prospectively enrolled 110 ICAS-LVOS patients (Jan 2020–Dec 2024). Hourly SBP was recorded for 24 h post-EVT. BPV metrics included standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and fluctuation frequency (|∆SBP| ≥ 10 mmHg). Outcomes included early favorable prognosis [National Institutes of Health Stroke Scale (NIHSS) ≤ 7], early neurological deterioration (ΔNIHSS ≥ + 2), and hemorrhagic transformation (HT).

110 patients were recruited. Generalized estimating equation analyses demonstrated that higher hourly SBP levels and higher |∆SBP| showed an associated with a decreased likelihood of NIHSS ≤ 7 and an increased risk of ΔNIHSS ≥ + 2. Logistic regression confirmed that lower mean SBP (p = 0.004), maximum SBP (p = 0.001), SD (p = 0.026), CV (p = 0.021), and ARV (p = 0.018) were significantly associated with NIHSS≤7. Conversely, higher mean SBP (p = 0.03), max SBP (p = 0.016), SD (p = 0.017), CV (p = 0.014), ARV (p = 0.008), and |∆SBP| ≥ 10 mmHg frequency (p = 0.045) independently was correlated with ΔNIHSS≥ + 2. No correlation was found between BP and HT. Subgroup analyses revealed that stroke location modified the effect of ARV on NIHSS≤7 (p = 0.007) and mean SBP on ΔNIHSS≥ + 2 (p = 0.024).

Higher post-EVT SBP levels and greater SBP variability were associated with reduced early recovery and an increased risk of neurological deterioration in ICAS-LVOS. Blood pressure should be maintained at a relatively low, consistent level.

Figures