Abstract WP048: In-Hospital Blood Pressure Variability Is Associated with Large Infarct Growth in Patients Undergoing Mechanical Thrombectomy

Background: Large vessel occlusion (LVO) stroke is characterized by impaired autoregulation and reliance on systemic blood pressure (BP) for collateral perfusion. Beyond absolute BP targets, in-hospital systolic BP (SBP) variability may influence tissue fate through intermittent hypoperfusion or reperfusion injury. Its impact on infarct growth after thrombectomy remains poorly understood. Methods: We retrospectively analyzed patients with anterior circulation LVO who underwent thrombectomy and had baseline and follow-up MRI (DWI and perfusion) performed within 16–48 hours. Infarct core volumes were measured on ADC maps (ADC < 620 × 10 -6 mm 2 /s). Infarct growth percentage, calculated as ((follow-up – baseline)/baseline) ×100, was used to normalize for baseline size. In-hospital SBP variability was assessed from all noninvasive readings within 24 hours using standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM). Patients were stratified into tertiles for each metric. Multivariable linear regression adjusted for confounders was used to assess associations between SBP variability and infarct growth. Results: Of 1,650 screened patients, 138 met inclusion (mean age 69 ± 14.6 years; 55% male). After adjusting for confounders, the highest tertile (T3) was significantly associated with greater infarct growth compared with the lowest tertile (T1), including SBP SD (β = 151.4; 95% CI 8.0–294.8; p = 0.039), SBP CV (β = 137.7; 95% CI –0.18 to 275.5; p = 0.050), and SBP VIM (β = 167.2; 95% CI 29.6–304.7; p = 0.018). Higher reperfusion grades were independently protective. Compared with incomplete recanalization, TICI 2c was associated with smaller infarct growth in the SBP SD model (β = –361.7; p = 0.046), with similar trends for SBP CV (β = –356.97%; p = 0.051) and SBP VIM (β = –344.12%; p = 0.053). TICI 3 was consistently protective across all models (β –396.9% to –406.5%; p = 0.023–0.024). Conclusions: In patients with anterior circulation LVO undergoing thrombectomy, higher in-hospital SBP variability was independently associated with significantly greater infarct percent growth. Limiting SBP fluctuations may represent a modifiable target to reduce infarct expansion after reperfusion.