Abstract DP028: Venous Outflow and Outcomes After Endovascular Thrombectomy: Interaction With Blood Pressure Variability in a Post Hoc Analysis of the OPTIMAL-BP Trial

Introduction: Despite previous studies suggesting an association between venous outflow (VO) and clinical outcomes, the relationship between VO status and comprehensive efficacy and safety outcomes after endovascular thrombectomy (EVT), including the influence of systolic blood pressure variability (BPV), remains unclear. Patients and Methods: We performed a secondary analysis of the OPTIMAL-BP trial. Patients were categorized into unfavorable VO (cortical vein opacification score (CVOS) <3) or favorable VO (CVOS ≥3). Efficacy outcomes included modified Rankin Scale (mRS) scores of 0–2 and 0–3 at three months, excellent NIHSS recovery, and final infarction volume (FIV). Safety outcomes consisted of any intracerebral hemorrhage (ICH), symptomatic ICH, any parenchymal hemorrhage (PH), PH type 2, and subarachnoid hemorrhage (SAH). BPV parameters, including time rate (TR), standard deviation, coefficient of variation, and variation independent of mean, were calculated within the first 24 hours after randomization. Results: Among 226 patients, unfavorable VO significantly correlated with lower odds of achieving mRS 0–2 (adjusted odds ratio [aOR], 0.44 [95% CI, 0.22–0.87]), mRS 0–3 (aOR, 0.39 [0.20–0.73]), excellent NIHSS recovery (aOR, 0.40 [0.15–0.95]), and increased FIV (adjusted coefficient, 37.18 [14.81–59.55]). It was also associated with increased odds of any ICH (aOR, 2.28 [1.20–4.39]), symptomatic ICH (aOR, 9.82 [3.12–39.40]), any PH (aOR, 6.08 [2.76–14.07]), PH type 2 (aOR, 174.59 [14.41–7276.24]), and SAH (aOR, 2.44 [1.13–5.29]). Only increased systolic BPV TR correlated significantly with poorer efficacy outcomes in unfavorable VO group. Sensitivity analyses using a Bayesian approach yielded results consistent with the primary analysis Conclusion: Unfavorable VO was associated with poorer clinical and safety outcomes after successful recanalization following EVT and increased post-EVT BPV further worsened clinical outcomes only in unfavorable group. These finding suggest that BPV modulation may improve prognosis in stroke patients with unfavorable VO.