ABSTRACT NUMBER: ESOC2026A1032 EARLY BLOOD PRESSURE CONTROL AND HEMATOMA EXPANSION AFTER MECHANICAL THROMBECTOMY WITH POSTPROCEDURAL INTRACRANIAL HEMORRHAGE

Abstract Background and aims Although intensive blood pressure (BP) lowering after mechanical thrombectomy (MT) has not improved outcomes overall, optimal BP management after postprocedural intracranial hemorrhage remains uncertain. Methods We retrospectively analyzed patients with acute ischemic stroke who underwent MT between 2014 and 2023 at a comprehensive stroke center. Patients achieving effective reperfusion (eTICI ≥2b50) and demonstrating ICH on immediate postprocedural CT, classified using the Heidelberg Bleeding Classification, were included. Early BP control was defined as achieving systolic BP (SBP) ≤140 mmHg within 2 hours after MT and maintaining it for subsequent 6 hours. The primary outcome was hematoma expansion within 24 hours, defined as progression of hemorrhagic subtype or increased hemorrhage volume on follow-up CT. Secondary outcomes included favorable outcome at 90 days (modified Rankin Scale [mRS] 0–2 or equal to premorbid mRS) and 90-day mortality. Results Among 781 MT-treated patients, 202 were included (early BP control: n=129; non-achievement: n=73). The BP control group had lower admission SBP and more frequent premorbid antithrombotic use. Procedural characteristics, including reperfusion status, were comparable. Subarachnoid hemorrhage was the most frequent hemorrhagic subtype in both groups and more frequent in the BP control group (48.8% vs 34.3%). Hematoma expansion was not statistically significant but tended to be less frequent (13.2% vs 20.6%; adjusted OR 0.48, 95% CI 0.20–1.18), with numerically lower mortality (5.4% vs 12.3%) and comparable favorable outcome (45.7% vs 43.8%). Conclusions Early achievement and maintenance of SBP ≤140 mmHg after MT may be associated with lower risk of hematoma expansion in patients with postprocedural ICH. Conflict of interest Naruhiko Kamogawa, nothing to disclose. Tomohide Yoshie, nothing to disclose. Hirotoshi Imamura, nothing to disclose. Hiroyuki Ishiyama, nothing to disclose. Satoru Fujiwara, nothing to disclose. Ryoma Inui, nothing to disclose. Hiroharu Kataoka, nothing to disclose. Masafumi Ihara, nothing to disclose. Kazunori Toyoda reports honoraria from Janssen Pharmaceuticals and Daiichi Sankyo. Masatoshi Koga reports honoraria from Daiichi Sankyo and research funding from Boston Scientific and Daiichi Sankyo.