Blood Pressure Variability in Ischemic Stroke Patients Status Post Thrombectomy

Introduction: Patients with an acute ischemic stroke involving the larger and medium vessels may receive a thrombectomy as part of their treatment. Following thrombectomy, 42% of patients will experience hemorrhagic transformation (HT). Documented HT risk factors include large core and penumbra size, increased mismatch volume, elevated blood pressure, and hyperglycemia. While there are blood pressure (BP) goals of < 180/105 following thrombectomy, there is no literature to evaluate the effect of blood pressure variability (BPV). This study sought to identify if BPV correlated to risk of HT following thrombectomy.


Methods: This retrospective evaluation assessed acute ischemic stroke patients who had an Interventional Radiology procedure between April 2019 and 2024. All adult patients with a primary diagnosis of ischemic stroke were included. Patients were excluded if a thrombectomy was not performed, was performed >24 hours from presentation, or if a stent was placed. BPV was assessed from presentation to procedure, intra-procedure, and up to 72 hours post-procedure or until HT, whichever occurred first. Primary outcome was BPV threshold that may indicate HT.


Results: For the preliminary results, 90 patients were included, 29 with HT and 61 without. Baseline characteristics were similar including age, gender, and medications prior to arrival. Initial NIHSS was 16-18 and almost all patients received thrombolytics. The average time from door to thrombectomy start was 1.7 hours. A majority of patients had a good reperfusion score post-thrombectomy. There were three potential BPV predictors of HT: systolic BP, co-efficient of variation post-procedure and encounter-wide, and 24 hour-weighted diastolic BP encounter-wide. A logistic regression identified systolic BP peri-procedure as a potential indicator of HT (OR 0.42, 90% CI 0.18-0.97). The presence of HT and systolic BP co-efficient of variation peri-procedure were independent risk factors for in-hospital mortality.


Conclusions: These preliminary results indicate BPV may be associated with the risk of HT. Further appropriately powered studies are needed to identify the clinical significance of these findings.