Rapid Assessment of Blood Pressure Variability and Outcome after Successful Thrombectomy

Background and Purpose: High blood pressure (BP) variability after endovascular stroke therapy is associated with poor outcome. Conventional BP variability measures require long recordings, limiting their utility as a risk assessment tool to guide clinical decision-making. Here, we performed rapid assessment of BP variability by spectral analysis and evaluated its association with early clinical improvement and long-term functional outcomes. Methods: We conducted a prospective study of 146 patients with anterior circulation ischemic stroke who underwent successful endovascular stroke therapy. Spectral analysis of 5-minute recordings of beat-to-beat BP was used to quantify BP variability. Outcomes included initial clinical response and modified Rankin Scale at 90 days. Results: Increased BP variability at high frequencies was independently associated with poor functional outcome at 90 days (adjusted odds ratio [aOR], 1.85 [95% CI, 1.07–3.25], P =0.03; low-/high-frequency ratio aOR, 0.67 [95% CI, 0.46–0.92], P =0.02) and reduced likelihood of an early neurological recovery (aOR, 0.62 [95% CI, 0.44–0.91], P =0.01 and aOR, 1.37 [95% CI, 1.03–1.87], P =0.04, respectively). Conclusions: High-frequency BP oscillations after successful reperfusion may be harmful and associate with a decreased likelihood of neurological recovery and favorable functional outcomes. Rapid assessment of BP variability throughout the postreperfusion period is feasible and may allow for a more personalized BP management.