Objective/Purpose Mechanical thrombectomy (MT) has become the standard of care for patients with acute ischemic stroke with large vessel occlusion; however, there are still no well-established guidelines for blood pressure (BP) management after this groundbreaking procedure. The purpose of this study was to evaluate whether variance in BP management in the first 24 hours after MT has a measurable effect on patient outcome.

Methods We conducted a retrospective cohort study in consecutive ischemic stroke patients who underwent MT at our comprehensive stroke center between January 2013 and August 2017. Eligible patients were included for analysis of maximum, minimum, average systolic and diastolic BP on arrival and in the first 24 hours after the MT. For the functional outcome measures, discharge and after 90 days modified Rankin scale (mRS) were utilized. The effect of BP management on outcome was analyzed using multivariable regression analysis.

Results Among the 216 consecutive patients admitted after MT for acute ischemic stroke in the defined time, 83 (38.4%) met all inclusion criteria, and 41 (49%) had a good functional outcome with mRS of 0–3 at 90 days. Average systolic BP was 128.4 mmHg (range 96.9 - 152.2 mmHg) in the first 24 hours after MT. Of all measures investigated, increasing age of the patient (R² = 0.41, p = 0.0001), elevated systolic BP on arrival (R² = 0.34, p = 0.0015), and maximum systolic BP in the first 24 hours (R² = 0.30, p = 0.005) were associated with poor functional outcomes at discharge and 90 days. No significant difference in functional status was observed when evaluating the average BP maintained during the first 24 hours after MT (R² = 0.15, p = 0.16) or the ethnicity of the patient (R² = 0.08, p = 0.46).

Conclusion Increasing age, elevated systolic BP on arrival, and maximum systolic BP in the first 24 hours after MT were associated with worsened outcomes in our single-center retrospective study. Prospective, multicenter and randomized control trials are necessary to identify and establish future BP guidelines post MT.

Disclosures M. Farag: None. W. Yu: None. S. Suzuki: None.