Pulse pressure after thrombectomy predicts functional outcomes and mortality in acute ischemic stroke with large artery occlusion

Post-procedure blood pressure (BP) strongly influences the prognosis of ischemic stroke patients with large vessel occlusion. However, no consensus or guidelines currently exist regarding BP targets and management after endovascular thrombectomy (EVT). Although several recent clinical trials have investigated BP management after EVT, their conclusions were inconsistent and contradictory. In this study, we systematically analyzed 12 post-procedure BP parameters from 826 acute ischemic stroke patients within 24 h after EVT; 587 cases were included in the final analysis. We utilized multivariate logistic regression to identify predictors of poor prognosis and mortality after EVT. Restrictive cubic splines were used to evaluate dose-response relationships of mean pulse pressure (PP) with clinical outcomes. Subgroup analyses were conducted to assess the predictive performance of mean PP across patient subgroups. Mean PP demonstrated statistically significant positive dose-response relationships with poor functional outcomes, symptomatic intracranial hemorrhage (sICH), and mortality after EVT. Elevated mean PP (> 57.39 mmHg) was a stronger predictor of adverse outcomes relative to systolic or diastolic BP alone; it exhibited the highest adjusted odds ratio (aORs 2.39; 95% confidence interval [CI] 1.58-3.62) and area under the curve (AUC = 0.661; 95% CI 0.617-0.705). Mean PP exhibited linear relationships with all other outcome events except mortality at 12 months after EVT. Mean PP within 24 h after EVT is an independent risk factor for sICH, poor functional outcomes, and mortality in stroke patients. BP management strategies should prioritize reducing systolic BP and stabilizing PP fluctuations.