Abstract DP031: Assessing the Associations between Intravenous Antihypertensives, Cerebral Autoregulation, and Functional Outcome after Mechanical Thrombectomy

Introduction: Early antihypertensive (Anti-HTN) treatment after successful mechanical thrombectomy (MT) has been associated with worse outcomes, but the physiologic mechanisms and at-risk subgroups remain unclear. We hypothesized that anti-HTN use increases time outside the personalized autoregulatory range, thereby predisposing patients to secondary brain injury. Methods: From our prospectively maintained stroke database, we identified patients who underwent MT for large-vessel occlusion in the anterior circulation and received continuous cerebral autoregulation monitoring during the first 24 hours post-procedure. The cerebral oximetry autoregulatory index was derived as a moving correlation coefficient between arterial blood pressure and near-infrared spectroscopy–based cerebral oxygenation. This index was used to define each patient’s autoregulatory limits and optimal mean arterial pressure (MAPopt). We then compared (1) the absolute deviation between observed MAP and MAPopt and (2) the percentage of time spent outside the autoregulatory range between patients who received Anti-HTN and those who did not, using Mann–Whitney U test. Multivariable logistic regression was applied to assess the independent associations of Anti-HTN use and autoregulatory impairment with poor 3-month functional outcome (mRS > 2). Results: A total of 177 patients were included. Patients who received Anti-HTN therapy demonstrated significantly greater deviations between observed MAP and MAPopt (p=0.03, Table 1). They also spent a larger proportion of time outside the autoregulatory range over 24 hours, although this difference was not statistically significant (37.5% vs 33.4%, p=0.3). In multivariable logistic regression, both Anti-HTN treatment (adjusted OR 3.8; 95% CI 1.4–12.8; p=0.02) and time spent outside the autoregulatory range (adjusted OR 1.5; 95% CI 1.1–1.9; p=0.006) were independently associated with poor 3-month outcomes (Table 2). No interaction was observed between Anti-HTN use and autoregulatory impairment on outcome. Conclusions: Early Anti-HTN therapy after MT was associated with greater deviations from MAPopt and increased likelihood of poor functional recovery. These findings suggest that lowering blood pressure in the early post-reperfusion period may worsen outcomes by disrupting personalized autoregulatory physiology. Autoregulation-guided hemodynamic management may help identify patients at risk and inform tailored strategies to optimize recovery after stroke.