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Huaishun Wang,1,* Chi Zhang,2,* Longdong Xu,3,* Jiaping Xu,1,* Guodong Xiao1,* 1Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People’s Republic of China; 2Department of Neurology, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, Jiangsu, 215000, People’s Republic of China; 3Department of Neurology, The Fifth People’s Hospital of Changshu, Changshu, Jiangsu, 215500, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guodong Xiao; Jiaping Xu, Department of Neurology and Suzhou Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People’s Republic of China, Email yarrowshaw@hotmail.com; simba481@163.comBackground and Purpose: Elevated heart rate (HR) after mechanical thrombectomy (MT) was associated with an increased risk of adverse outcomes. However, optimal HR management after MT remains unclear. This study aimed to identify patient subgroups with distinct HR trajectories after MT and explore their association with outcomes.Methods: Acute ischemic stroke patients undergoing MT therapy were prospectively recruited from July 2020 to December 2022. Their heart rate indicators were collected every hour for 72 hours after MT procedure. Latent variable mixture modeling was used to separate subjects into five groups with distinct HR trajectories. The primary outcome was poor functional outcome (mRS score > 2) at 3 months. Additional outcome was all-cause mortality (mRS score = 6) at 3 months.Results: A total of 224 patients with large vessel occlusion were enrolled, with a mean age of 65.2+14.0 years. Eighty-seven patients had a good functional outcome, and 137 patients had a poor functional outcome. Five distinct HR trajectories were observed: low (19.2%)