Mean systolic blood pressure upon admission and clinical outcomes after endovascular treatment in patients with large vessel occlusion beyond 24 hours

Background and purpose: Recently, several clinical studies have shown that higher systolic blood pressure (SBP) upon admission is associated with poor clinical outcomes in patients with ischemic stroke following endovascular treatment (EVT). However, the effect of the mean systolic blood pressure (MSBP) upon admission on patients with acute anterior circulation large vessel occlusion (ACLVO) who underwent EVT after 24 h is unclear. We sought to assess the association between MSBP at admission and clinical outcomes in patients treated with EVT for acute ACLVO beyond 24 h after onset. Methods: Patients with ACLVO treated with EVT more than 24 h after symptom onset were consecutively enrolled during a 3-year period at a tertiary stroke center. MSBP was measured at admission using an automatic cuff recording. The efficacy outcome was a 3-month good functional outcome (modified Rankin Scale score of 0-2). Symptomatic intracerebral hemorrhage (sICH) and mortality at 3 months were the safety outcomes. Results: A total of 57 patients with acute ischemic stroke who met the inclusion criteria were included in the study (mean age 56 ± 12 years, mean National Institute of Health Stroke Scale score 11 ± 5). In the Firth penalized likelihood logistic regression analyses adjusted for confounding factors, higher MSBP levels were significantly negatively correlated with good clinical outcomes (odds ratio: 0.012; 95% confidence interval: 0.000-0.204). There was no significant association between high SBP and sICH or mortality. Conclusion: Our study suggests that higher MSBP at admission is an independent predictor of a poor clinical outcome at 3 months in patients treated with EVT for acute ACLVO beyond 24 h after onset.