Short-term Blood Pressure Variability After Successful Re-canalization Is Associated with Discharge Outcomes in Large Vessel Occlusion Strokes

Objective: Our objective was to assess the role of blood pressure (BP) variability in predicting discharge outcomes in successfully re-canalized (TICI 2b-3) large vessel occlusion strokes (LVOs) strokes. Background: Blood pressure variability affects early neurological deterioration and clinical outcomes in acute ischemic stroke. Evidence to guide post re-canalization blood pressure changes is currently lacking. Design/Methods: The study includes retrospective analysis of 182 LVO stroke patients between the years 2015–19. Anterior circulation LVO stroke patients, who were successfully re-canalized (TICI 2b-3) within 6 hours of time since last seen normal were included in this retrospective analysis (n=87). BP measurements were collected hourly for the first 24 hours post re-canalization. Squared average real BP variability (ARV2) was calculated for systolic (SBP) and mean blood pressures (MAP). We compared four quartiles of ARV2 (Q1 the least and Q4 highest variability) using dichotomous outcome variables - modified Rankin Scale (mRS) 5. The outcomes were adjusted for potential confounders including age, tPA, use of General Anesthesia (GA) and hemorrhagic events. Results: All four ARV2 quartiles had similar baseline characteristics. Favorable outcomes (mRS ≤ 2) were significantly higher (aOR: 0.17 [0.03 – 0.80], p=0.034) in Q1 of the ARV2 MAP (45%) compared to the Q4 patients (18%). While 50% of patients in SBP ARV2 Q1 had favorable outcomes (i.e., mRS ≤ 2), only 23% of Q4 patients experienced such outcomes. (0.32 [0.08 – 1.20], p= 0.100) SBP ARV2 result was not statistically significant, though followed expected direction. Conclusions: Less blood pressure variability (ARV2) for MAP- in the first 24 hours after TICI 2b-3 re-canalization of LVOs is associated with a discharge mRS ≤ 2. Impact of blood pressure variability (ARV2) on long-term functionality outcomes in successfully re-canalized LVO stroke patients needs further detailed exploration. Disclosure: Dr. Das has nothing to disclose. Dr. Chandler has nothing to disclose. Dr. Elliott has nothing to disclose. Dr. Furmanek has nothing to disclose. Dr. Liu has nothing to disclose. Dr. Remmel has nothing to disclose. Dr. Akca has nothing to disclose.