Prognostic value of beat-to-beat blood pressure variability parameters in patients after mechanical thrombectomy

The relationship of beat-to-beat blood pressure variability (BPV) with prognosis after mechanical thrombectomy (MT) is unclear. Consecutive patients with acute ischemic stroke with large vessel occlusion treated with and without MT matched 1:1 by age, sex, and National Institutes of Health Stroke Scale were included. Beat-to-beat BPV was calculated for both systolic (SBP) and diastolic blood pressure (DBP) as standard deviation, coefficient of variation, successive variation (SV), and average real variability (ARV) at 24-72 h after MT. Additionally, hour-to-hour (first 24 h after MT) and day-by-day BPV (first 7 days after MT) were also measured. The outcome was modified Rankin Scale (mRS) at 3 months. Of 168 patients, 84 patients received MT and 84 did not. MT closely correlated with lower beat-to-beat BPV parameters. Beat-to-beat SBP-SV and SBP-ARV were significantly higher in patients with unfavorable outcome than in those with favorable outcome (median 3.40 vs 2.71; P = 0.016; median 2.81 vs 2.20, P = 0.003). After adjusting for confounders, higher beat-to-beat SBP-SV and SBP-ARV were independently associated with unfavorable outcome in patients with MT (all P < 0.05). However, no association was found between hour-to-hour and day-by-day BPV and outcome at 3 months (P > 0.05). The patients with MT had lower beat-to-beat BPV values in the acute phase, which indicated that MT has a positive effect on beat-to-beat BPV. Furthermore, beat-to-beat BPV, rather than hour-to-hour or day-by-day BPV, is an independent risk factor for unfavorable outcome in patients after MT.