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Association of blood pressure and outcomes differs upon cerebral perfusion post-thrombectomy in patients with acute ischemic stroke
  1. Jinjie Liu1,
  2. Ximing Nie1,2,
  3. Zhe Zhang1,2,
  4. Wanying Duan1,2,
  5. Xin Liu1,2,
  6. Hongyi Yan1,2,
  7. Lina Zheng1,2,
  8. Changgeng Fang1,2,
  9. Jiaping Chen1,2,
  10. Yuyi Wang1,2,
  11. Zhixuan Wen1,2,
  12. Shuning Cai1,2,
  13. Miao Wen1,2,
  14. Zhonghua Yang1,2,
  15. Yuesong Pan1,2,
  16. Sibo Liu3,
  17. Liping Liu1,2
    1. 1Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    2. 2China National Clinical Research Center for Neurological Diseases, Beijing, China
    3. 3Surgical Intensive Care Unit, Dalian University of Technology Affiliated Central Hospital (Dalian Central Hospital), Dalian, Liaoning, China
    1. Correspondence to Liping Liu, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China, No.119, South 4th Ring West Road, Fengtai District; lipingsister{at}


    Background The relationship between post-endovascular thrombectomy (EVT) blood pressure (BP) and outcomes in patients with acute ischemic stroke (AIS) remains contentious. We aimed to explore whether this association differs with different cerebral perfusion statuses post-EVT.

    Methods In a multicenter observational study of patients with AIS with large vessel occlusion who underwent EVT, we enrolled those who accepted CT perfusion (CTP) imaging within 24 hours post-EVT. We recorded post-EVT systolic (SBP) and diastolic BP. Patients were stratified into favorable perfusion and unfavorable perfusion groups based on the hypoperfusion intensity ratio (HIR) on CTP. The primary outcome was good functional outcome (90-day modified Rankin Scale score of ≤3). Secondary outcomes included early neurological deterioration, infarct size growth, and symptomatic intracranial hemorrhage.

    Results Of the 415 patients studied (mean age 62 years, 75% male), 233 (56%) achieved good functional outcomes. Logistic regression showed that post-EVT HIR and 24-hour mean SBP were significantly associated with functional outcomes. Among the 326 (79%) patients with favorable perfusion, SBP <140 mmHg was associated with a higher percentage of good functional outcomes compared with SBP ≥140 mmHg (68% vs 52%; aOR 1.70 (95% CI 1.00 to 2.89), P=0.04). However, no significant difference was observed between SBP and functional outcomes in the unfavorable perfusion group. There was also no discernible difference between SBP and secondary outcomes across the different perfusion groups.

    Conclusions In patients with favorable perfusion post-EVT, SBP <140 mmHg was associated with good functional outcomes, which underscores the need for further investigations with larger sample sizes or a more individualized BP management strategy.

    Clinical trial registration ChiCTR1900022154.

    • Blood Pressure
    • Stroke
    • Thrombectomy
    • CT perfusion

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

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    • Contributors JJL: Conceptualization, investigation, writing – original draft, funding acquisition. XMN: Conceptualization, methodology, project administration, writing – review and editing. ZZ: Conceptualization, investigation, data curation. WYD: Investigation, data curation. XL: Investigation, data curation. HYY: Formal analysis, methodology, software. LNZ: Investigation, data curation. CGF: Investigation, data curation. JPC: Investigation, data curation. YYW: Investigation, data curation. ZXW: Investigation, data curation. SNC: Investigation, data curation. MW: Conceptualization, investigation, data curation. HHY: Conceptualization, investigation, data curation. YSP: Investigation, data curation. SBL: Software, visualization, writing – original draft, formal analysis, funding acquisition. LPL: Conceptualization, methodology, funding acquisition, supervision, writing – review and editing, guarantor. All named authors contributed substantially to the work described by actively participating in the study and the generation of the data, and provided critical evaluation of the manuscript.

    • Funding This research was funded by the National Natural Science Foundation of China (Grant Numbers: 82071301, 81820108012, 82001920), the Beijing Hospitals Authority Youth Programme (Grant Number: QML20210503), and the Dalian High-Level Talent Innovation Support Plan (Youth Science and Technology Star Project, Grant Number: 2021RQ029, 2023RY019).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.