Blood pressure management in patients receiving rescue stenting after failed endovascular treatment in large vessel occlusion acute ischaemic stroke: a multicentre registry

Abstract Objectives Rescue stenting (RS) has emerged as a bailout strategy after failed reperfusion during endovascular treatment (EVT). Optimal blood pressure (BP) management after RS remains unclear. Our aim is to evaluate the association of BP levels and blood pressure variability (BPV) during the first 24 h after RS with short-term and long-term patient outcomes. Methods We performed a retrospective analysis of an international registry where data from adult patients who underwent either RS or rescue angioplasty after failed EVT were collected. Patients who received RS with large vessel occlusion and at least 4 BP measurements in the first 24 h were included. Results RS was performed in 437 patients (40.5% female, mean age 67.1 ± 13 years). Admission median National Institutes of Health Stroke Scale score was 12 (IQR 7–18) and history of hypertension was present in 74.2% of patients. Μean Systolic BP (SBP) in the first 24 h was 137.4 ± 14.6 mmHg. Higher values of BPV (coefficient of variation, standard deviation, average real variability and successive variation) were associated with lower odds for Modified Rankin Scale score 0–2 at 90 days (adjusted odds ratio ranging 0.55 [0.38, 0.79] to 0.99 [0.98, 0.99] per 10 units increase). No associations were found between any SBP measure and death, sICH as well as neurological deterioration at 24 h. Conclusion In our study, higher BPV was associated with worse clinical outcomes in stroke patients treated with RS as bailout therapy after failed reperfusion. No association was shown between mean, maximum, minimum and delta SBP and clinical outcomes.

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Journal
European Stroke Journal
Published
2026-05-01
DOI
https://doi.org/10.1093/esj/aakag035
Primary Topic
Acute Ischemic Stroke Management
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article
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article

Blood pressure management in patients receiving rescue stenting after failed endovascular treatment in large vessel occlusion acute ischaemic stroke: a multicentre registry

Alex Brehm, Victoria Hellstern, D Weiß, Violiza Inoa‐Acosta et al.
European Stroke Journal
Acute Ischemic Stroke Management
article

Blood pressure management in patients receiving rescue stenting after failed endovascular treatment in large vessel occlusion acute ischaemic stroke: a multicentre registry

Alex Brehm, Victoria Hellstern, D Weiß, Violiza Inoa‐Acosta, B Valverde, F Hui, Nikki Rommers, Vittorio Semeraro, Umesh Bonala, Vivek Batra, Maria Porzia Ganimede, Tomás Carmona, Massimo Muto, Vera Aebischer, Adnan Mujanović, Paolo Remida, Aaisha Mozumder, Manuel Bolognese, Luca Valvassori, Claudia Rollo, J Clarke, Agostino Tessitore, Gianmarco Bernava, Aristeidis H. Katsanos, Shuntaro Kuwahara, Elena Ballabio, Matúš Hoferica, Susanna Diamanti, Diana Melância, Ilka Kleffner, Guillaume Thévoz, Johannes Gerber, Giulia Frauenfelder, Kazutaka Uchida, Frederic De Beukelaer, Mira Katan, Anirudh Joshi, Aikaterini Anastasiou, Sjoerd F M Jenniskens, A E Othman, M Kaschner, Marta de Dios Lascuevas, Bruno Bartolini, Daniel P O Kaiser, Jason Wenderoth, Christophe Cognard, Anil M Tuladhar, Dang Hoang-Tho, Alfonso López-Frías, Timo Uphaus, Patrik Michel, Michael R Levitt, Johannes Kaesmacher, Amedeo Cervo, Riitta Rautio, Luca Scarcia, Grzegorz Karwacki, Mohamad Abdalkader, Diana Aguiar de Sousa, Daniele Giuseppe Romano, Andrea M. Alexandre, Leonardo Renieri, Sergio Lucio Vinci, Paolo Machi, Flavio Giordano, Alessandro Pedicelli, Piers Klein, Marios-Nikos Psychogios, Wiesmann Martin, Marcel N Wolf, Nitin Goyal, Thanh N Nguyen, Erwah Kalsoum
article en

Abstract

Abstract Objectives Rescue stenting (RS) has emerged as a bailout strategy after failed reperfusion during endovascular treatment (EVT). Optimal blood pressure (BP) management after RS remains unclear. Our aim is to evaluate the association of BP levels and blood pressure variability (BPV) during the first 24 h after RS with short-term and long-term patient outcomes. Methods We performed a retrospective analysis of an international registry where data from adult patients who underwent either RS or rescue angioplasty after failed EVT were collected. Patients who received RS with large vessel occlusion and at least 4 BP measurements in the first 24 h were included. Results RS was performed in 437 patients (40.5% female, mean age 67.1 ± 13 years). Admission median National Institutes of Health Stroke Scale score was 12 (IQR 7–18) and history of hypertension was present in 74.2% of patients. Μean Systolic BP (SBP) in the first 24 h was 137.4 ± 14.6 mmHg. Higher values of BPV (coefficient of variation, standard deviation, average real variability and successive variation) were associated with lower odds for Modified Rankin Scale score 0–2 at 90 days (adjusted odds ratio ranging 0.55 [0.38, 0.79] to 0.99 [0.98, 0.99] per 10 units increase). No associations were found between any SBP measure and death, sICH as well as neurological deterioration at 24 h. Conclusion In our study, higher BPV was associated with worse clinical outcomes in stroke patients treated with RS as bailout therapy after failed reperfusion. No association was shown between mean, maximum, minimum and delta SBP and clinical outcomes.

European Stroke JournalVol. 11(5)
Università Cattolica del Sacro Cuore (IT), University of Messina (IT), Hebron University (PS), Boston Medical Center (US), AOL (United States) (US), University of Salerno (IT), University of Hawaii System (US), Hyogo Medical University (JP), University of Lisbon (PT), Radboud University Nijmegen (NL), Inserm (FR), University of Turku (FI), University of Tennessee Health Science Center (US), University of Lucerne (CH), Université Fédérale de Toulouse Midi-Pyrénées (FR), University of Basel (CH), Johannes Gutenberg University Mainz (DE), University of Washington (US), University Hospital of Bern (CH), Turku University Hospital (FI), University Hospital of Basel (CH), Agostino Gemelli University Polyclinic (IT), Population Health Research Institute (CA), Radboud University Medical Center (NL), Hospital Clínico San Carlos (ES), UNSW Sydney (AU), Ospedale Antonio Cardarelli (IT), Düsseldorf University Hospital (DE), University Medical Center of the Johannes Gutenberg University Mainz (DE), Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT), Centre Hospitalier Universitaire de Tours (FR), Hospital de São José (PT), Clinical Investigation Center Plurithematic Tours (FR), Queen's Medical Center (US), Prince of Wales Hospital (AU), Azienda Ospedaliera San Gerardo (IT), Universitätsklinikum Knappschaftskrankenhaus Bochum (DE), Semmes Murphey Foundation (US), Azienda Ospedaliero-Universitaria Careggi (IT), Universitätsklinikum Aachen (DE), Hôpitaux Universitaires Henri-Mondor (FR), Azienda Ospedaliera Universitaria Policlinico "G. Martino" (IT), Ospedale SS. Annunziata (IT), Hyogo Prefectural Nishinomiya Hospital (JP), Neurological Surgery (US), Klinikum Stuttgart (DE), University Hospital Carl Gustav Carus (DE), Heinrich Heine University Düsseldorf (DE), Geneva College (US), Hyogo University (JP), Kobe College (JP), RWTH Aachen University (DE), University of Lausanne (CH)
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