Post-Thrombectomy Pulse Pressure Trajectories and Outcomes in Middle-Aged and Older Stroke Patients

Chen Xiao,1,2 Feng Gao,3 Bailong Xin,2 Yuzhen Wang,4 Xintian Xu,4 Xiaomei Ye,4 Jingping Sun,2,4 Xueli Cai1,2,4 1Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 2Department of Neurology, Lishui Hospital of Zhejiang University (Lishui Municipal Central Hospital), Lishui, Zhejiang, People’s Republic of China; 3Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China; 4Lishui Clinical Research Center for Neurological Diseases, Lishui, Zhejiang, People’s Republic of ChinaCorrespondence: Xueli Cai, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, Zhejiang, 310058, People’s Republic of China, Email [email protected] Jingping Sun, Department of Neurology, Lishui Hospital of Zhejiang University (Lishui Municipal Central Hospital), 289 Kuocang Road, Lishui, Zhejiang, 323000, People’s Republic of China, Email [email protected]: Endovascular thrombectomy (EVT) is an established treatment for acute ischemic stroke in elderly patients. Nonetheless, age-specific vascular pathophysiology in this population presents distinct challenges for postprocedural blood pressure management. Pulse pressure has been linked to clinical outcomes, however, evidence regarding the impact of its dynamic patterns following EVT remains limited.Methods: This single-center retrospective cohort study included patients aged over 45 years who had achieved successful reperfusion following thrombectomy. Group-based trajectory modeling was applied to characterize the patterns of pulse pressure over the first 24 hours post-procedure. The primary outcome was functional status at 90 days, assessed using the modified Rankin Scale. The association between pulse pressure trajectories and functional outcome was examined using ordinal logistic regression, with adjustment for potential confounders. Furthermore, subgroup analysis was performed to assess whether this association differed between patients aged < 75 years and those ≥ 75 years.Results: Three distinct postoperative pulse pressure trajectories were identified: low-stable, moderate-increasing, and high-increasing. In the overall population, the moderate-increasing trajectory was associated with favorable 90-day functional outcomes after multivariate adjustment (adjusted OR, 0.52; 95% CI, 0.32– 0.85), while no significant association was observed between the high-increasing and low-stable trajectories. Subgroup analysis revealed a significant interaction between age and trajectory group (P for interaction < 0.05). The moderate-increasing trajectory was associated with better functional outcomes in patients aged ≥ 75 years (adjusted OR, 0.28; 95% CI, 0.13– 0.62), whereas no statistically significant association was observed in the younger subgroup.Conclusion: Among patients aged > 45 years undergoing EVT, the 24-hour pulse pressure trajectory is associated with 90-day functional outcome, and this association is modified by age. For patients aged 75 years or older, maintaining a moderate pulse pressure level may be associated with improved functional recovery.Keywords: blood pressure, stroke, thrombectomy, GBTM