Abstract DP251: Post-Endovascular Thrombectomy Microvascular Perfusion and Early Blood Pressure Trajectories

Background: Endovascular thrombectomy (EVT) is the standard treatment for acute ischemic stroke with large-vessel occlusion. However, some patients still experience early neurological deterioration or poor recovery despite successful recanalization. A potential explanation is impaired microvascular perfusion (IMP), where tissue-level flow remains insufficient despite proximal recanalization. Proposed mechanisms include microthrombi formation, endothelial injury, and blood-brain barrier disruption. In the presence of IMP, cerebral perfusion may become pressure-passive and more dependent on systemic blood pressure (BP). As BP typically rises at stroke onset to preserve perfusion, post-recanalization perfusion status may influence BP dynamics. In this study, we investigated whether post-EVT perfusion status influences early BP trajectories. Methods: We retrospectively analyzed a cohort from a single tertiary center (2014–2024) with successful recanalization (eTICI >=2b) and post-EVT MRI including DSC perfusion performed within 24 h. Post-EVT IMP was defined as the presence of a region with Tmax >6s within the recanalized territory, excluding infarct core (ADC