Time-Dependent Relationship between Blood Pressure Trajectory and Functional Outcomes after Endovascular Thrombectomy

Kyubong Lee; Jung Hoon Han; Chi Kyung Kim; Jeong Yoon Song; Hyunsun Oh; Keonyeup Kim; Wookjin Yang; Jun Young Chang; Dong-Wha Kang; Sun U Kwon; Seon Moon Hwang; Joon Ho Choi; Boseong Kwon; Yunsun Song; Deok Hee Lee; Sehee Kim; Bum Joon Kim

doi:10.1007/s12028-026-02464-9

Time-Dependent Relationship between Blood Pressure Trajectory and Functional Outcomes after Endovascular Thrombectomy

Neurocrit Care. 2026 Mar 9. doi: 10.1007/s12028-026-02464-9. Online ahead of print.

Authors

Kyubong Lee^#¹, Jung Hoon Han^#², Chi Kyung Kim¹, Jeong Yoon Song³, Hyunsun Oh³, Keonyeup Kim³, Wookjin Yang³, Jun Young Chang³, Dong-Wha Kang³, Sun U Kwon³, Seon Moon Hwang⁴, Joon Ho Choi⁴, Boseong Kwon⁴, Yunsun Song⁴, Deok Hee Lee⁴, Sehee Kim⁵, Bum Joon Kim⁶

Affiliations

¹ Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
² Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea.
³ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, South Korea.
⁴ Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
⁵ Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
⁶ Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-Gu, Seoul, South Korea. medicj80@hanmail.net.

^# Contributed equally.

PMID: 41803430
DOI: 10.1007/s12028-026-02464-9

Abstract

Background: The prognostic significance of spontaneous systolic blood pressure (SBP) reduction following endovascular thrombectomy (EVT) remains unclear, especially according to the timing of measurement. The optimal timing for initiating antihypertensive therapy in patients with elevated SBP after reperfusion is also uncertain.

Methods: We retrospectively analyzed 349 patients with acute ischemic stroke due to large vessel occlusion who underwent EVT between 2015 and 2024. SBP was recorded from the time of arrival at the emergency department through 24 h post-procedure. Patients were classified on the basis of whether their SBP dropped below 140 mm Hg immediately after recanalization or upon admission to the intensive care unit within 1 h after EVT (after stabilization). Use of BP-lowering agents administered immediately after recanalization was also recorded and analyzed. The primary outcome was good functional status (modified Rankin scale score 0-2) at 3 months.

Results: Among the 349 patients (mean age: 71.4 ± 10.4 years; 56.2% male), 45.0% had a mean SBP of less than 140 mm Hg immediately following recanalization. While SBP < 140 mm Hg immediately following recanalization did not show a significant association with the primary outcome, SBP < 140 mm Hg measured after stabilization (within 1 h post-EVT) was independently associated with good outcomes (adjusted odds ratio 6.92, 95% confidence interval 2.47-19.43, P < 0.001). The use of BP-lowering agents among those with elevated SBP immediately after recanalization did not show an independent association with the primary outcome.

Conclusions: SBP < 140 mm Hg after stabilization following EVT, rather than immediately after recanalization, was associated with good functional outcomes, regardless of the use of BP-lowering agents immediately after recanalization.