# 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.

## Key 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.