Association of intraoperative systolic blood pressure variability and clinical outcomes in mechanical thrombectomy: a retrospective cohort study

Abstract Background Intraoperative hemodynamic stability during mechanical thrombectomy (MT) is crucial for clinical recovery, but the prognostic significance of dynamic systolic blood pressure variability (SBPv) parameters, including SBP successive variability (SBPsv), maximum SBP (SBPmax), and minimum SBP (SBPmin), requires further investigation. We aimed to explore the relationship between these intraoperative parameters and patient clinical outcomes. Methods A total of 331 patients who received MT with general anesthesia were enrolled. Patients were dichotomized for each of the three intraoperative SBPv parameters (SBPsv, SBPmax, and SBPmin) using optimal cut‑off values derived from the maximally selected rank statistics. Functional recovery at 90 days was defined as the primary outcome. The 90-day all-cause mortality rate and symptomatic intracranial hemorrhage (sICH) were defined as the secondary outcomes. Logistic regression was performed to identify factors influencing sICH and functional recovery. Kaplan-Meier (KM) curves with log-rank tests and Cox regression were applied to evaluate survival outcomes. Results Patients in the SBPmax G2 group were less likely to achieve functional recovery compared with the G1 group (OR 0.617, 95%CI 0.393–0.970, P = 0.036). Kaplan-Meier survival curves with the log-rank test demonstrated significant survival differences between the two groups stratified by SBPmax (G2 vs. G1: χ² = 6.564, P = 0.010) and SBPsv (G2 vs. G1: χ² = 10.033, P = 0.002). Cox regression analysis showed that patients in the SBPmax G2 group had a significantly higher risk of 90-day mortality compared with the G1 group (HR 1.665, 95%CI 1.073–2.583, P = 0.023). Patients in the SBPsv G2 group also exhibited a significantly elevated mortality risk compared with the G1 group (HR 1.993, 95% CI 1.269–3.130, P = 0.003). No significant association was identified between intraoperative SBPv parameters and sICH. Conclusion In patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy under general anesthesia, abnormal intraoperative systolic blood pressure patterns appeared to be associated with unfavorable long‑term clinical outcomes. Individualized intraoperative blood pressure management may help optimize patient prognosis.