Association between Blood Pressure Variability and Clinical Outcomes after Successful Thrombectomy in Acute Basilar Artery Occlusion Stroke Patients: A Multicenter Cohort Study

Abstract

BackgroundLimited data are available on the appropriate choice of blood pressure management strategy for patients with acute basilar artery occlusion (BAO) treated with mechanical thrombectomy (MT). We evaluated the impact of blood pressure variability on clinical outcomes after MT in patients with acute BAO. MethodsThis multicenter cohort study included 108 patients with acute BAO who underwent successful emergency thrombectomy at two comprehensive stroke centers from 2016 to 2021. Blood pressure was measured hourly during the first 24 hours after successful reperfusion. Blood pressure variability was calculated as mean arterial pressure (MAP) assessed by the standard deviation (SD). Multivariate logistic models were used to investigate the association between BPV, the primary outcome (futile recanalization, 90‐day modified Rankin Scale score 3–6), and the secondary outcome (30-day mortality). Subgroup analysis was performed as a sensitivity test. ResultsFutile recanalization occurred in 60 (56%) patients, while 26 (24%) patients died within 30 days. In the fully adjusted model, MAP SD was associated with a higher risk of futile recanalization (OR adj=1.36, per 1 mmHg increase, 95% CI: 1.09–1.69, P=0.006) and 30-day mortality (OR adj=1.56, per 1 mmHg increase, 95% CI: 1.20–2.04, P=0.001). A significant interaction between MAP SD and the lack of hypertension history on futile recanalization (P<0.05) was observed. ConclusionsAmong recanalized acute BAO ischemic patients, higher blood pressure variability during the first 24 hours after MT was associated with worse outcomes. This association was stronger in patients without a history of hypertension.