Abstract
Objective
Peri‐procedural blood pressure (BP) management in the acute phase of stroke is associated with clinical outcomes among patients receiving endovascular therapy (EVT). This study aimed to investigate whether pre‐treatment collateral circulation status modifies the association between longitudinal systolic BP (SBP) trajectories and 90‐day clinical outcomes after successful EVT.
Methods
This study enrolled a total of 800 patients with ischemic stroke caused by large‐vessel occlusion in the anterior circulation who underwent successful recanalization. Latent mixture modeling was used to determine SBP trajectories according to 3 SBP measurements during the first 24 h after EVT. Collateral status prior to EVT was assessed by digital subtraction angiography. Clinical outcomes including stroke disability (modified Rankin Scale 3–6), mortality, and symptomatic intracranial hemorrhage (sICH) were collected 90 days after the stroke.
Results
Three SBP trajectories were identified: high (7%), moderate (57.9%), and low (35.1%) SBP. After multivariable adjustment, SBP trajectories were independently associated with unfavorable 90‐day functional outcomes (
p
= 0.012), whereas no significant differences in mortality and sICH were detected across the three SBP trajectory groups. Patients with high and moderate SBP trajectories had an elevated risk of unfavorable outcomes in the poor collateral (adjusted odds ratio, 6.19 [95% CI, 2.17–17.67],
p
p
= 0.007, respectively) rather than good collateral (
P
for interaction: 0.042).
Conclusions
Patients with high or moderate SBP trajectories during the first 24 h after successful recanalization had a higher risk of unfavorable outcomes among patients with poor collateral.