Abstract TP411: Distinct Systolic Blood Pressure Trajectories 72 Hours After Mechanical Thrombectomy Predict Hemorrhagic Transformation and Poor Functional Outcome

Abstract

Introduction: Current stroke guidelines recommend maintaining systolic blood pressure (SBP) below 180 mmHg after thrombolysis, and this standard has carried over for post-thrombectomy blood pressure (BP) management. However, optimal BP management after mechanical thrombectomy (MT) remains unclear and BP beyond 24 hours after thrombectomy is not well-studied. We investigated how 72-hour SBP trajectories after MT may predict patient outcome. Methods: We retrospectively studied patients with large-vessel occlusion stroke who underwent MT. BP was non-invasively recorded hourly for the first 72 hours. Hemorrhagic transformation (HT) was measured on 24-hour CT scans using ECASS II classification. Functional outcome was assessed using the modified Rankin Scale (mRS). SBP trajectories between groups were compared using generalized estimating equations. All analyses were adjusted for age, admission NIHSS, and recanalization status. Results: Seventy-three patients (mean age 72±14, 40F, mean NIHSS 18) were analyzed. Patients with poor 90-day functional outcome (mRS >3) had higher mean SBP over the first 24 hours compared to those with favorable outcome (136 vs. 128 mmHg, p=0.017) and demonstrated distinct BP trajectories over the first 72 hours (Figure 1A). Patients with poor functional outcome had higher SBP directly after MT (155 vs. 141 mmHg) and their pressures dropped less during the first 12 hours when compared to those with favorable outcomes (p=0.018). Similarly, mean SBP and SBP trajectories of patients with HT were significantly different from those without HT (Figure 1B, p=0.050). By 72 hours, SBP trajectories were similar, regardless of functional outcome or HT. Conclusions: During the first 72 hours after MT, acute ischemic stroke patients show distinct SBP trajectories, which differ in relation to functional outcome and hemorrhagic transformation. The findings may help recognize potential candidates for future blood pressure control trials.