Abstract WP008: Systolic Blood Pressure Variability Beyond 24 Hours After Successful Reperfusion Following Mechanical Thrombectomy Is Associated with Poor Outcomes

Background: Strict blood pressure (BP) lowering after successful reperfusion by mechanical thrombectomy (MT) has been reported to increase the risk of poor outcomes, but the association between BP variability and functional outcomes remains unclear. Methods: We retrospectively analyzed 342 consecutive MT patients treated between May 2014 and June 2025. Systolic BP (SBP) values were collected from immediately after reperfusion to 72 hours (h) post-MT. BP variability was calculated as variability independent of the mean (VIM), time rate (TR), and coefficient of variation (CV). Patients with successful reperfusion [≥modified Thrombolysis in Cerebral Infarction (mTICI) 2b] were included. The primary outcome was poor functional outcome at 90 days [modified Rankin Scale (mRS) 4–6]. Associations between BP variability and poor outcomes or symptomatic intracranial hemorrhage (sICH) were assessed using multivariable logistic regression. Results: Among 270 patients, 176 (62.9%) had poor outcomes and 104 (37.1%) had favorable outcomes. In univariate analysis, only 0–72 h SBP VIM was significantly higher in the poor outcome group (median 13.9 vs. 13.1, P =0.026). Multivariable logistic regression identified 0–72 h SBP VIM as independently associated with poor outcome [adjusted odds ratio (aOR) 1.07, 95% confidence interval (CI) 1.03–1.12, P =0.001]. VIM was also associated with sICH (aOR 0.87, 95%CI 0.79–0.94, P <0.001). Notably, only 24–72 h VIM remained independently associated with poor outcome (aOR 1.07, 95%CI 1.02–1.12, P =0.005). Even after excluding 22 patients with sICH, 24–72 h VIM remained significantly associated with poor outcome (aOR 1.06, 95%CI 1.01–1.11, P =0.023). Conclusions: In patients with large vessel occlusion, higher SBP VIM during 24–72 h after successful reperfusion was independently associated with poor functional outcome, regardless of sICH. Efforts to optimize BP variability not only within the first 24 h but also during 24–72 h may contribute to improved clinical outcomes.