Impact of blood pressure levels and variability after successful revascularization on the prognosis in ICAS-LVOS patients

Background Optimal blood pressure management after endovascular treatment (EVT) for intracranial atherosclerosis-related large vessel occlusion stroke (ICAS-LVOS) remains uncertain. This study evaluated the impact of systolic blood pressure (SBP) and blood pressure variability (BPV) on early outcomes following successful recanalization. Methods We prospectively enrolled 110 ICAS-LVOS patients (Jan 2020–Dec 2024). Hourly SBP was recorded for 24 h post-EVT. BPV metrics included standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and fluctuation frequency (|∆SBP| ≥ 10 mmHg). Outcomes included early favorable prognosis [National Institutes of Health Stroke Scale (NIHSS) ≤ 7], early neurological deterioration (ΔNIHSS ≥ + 2), and hemorrhagic transformation (HT). Results 110 patients were recruited. Generalized estimating equation analyses demonstrated that higher hourly SBP levels and higher |∆SBP| showed an associated with a decreased likelihood of NIHSS ≤ 7 and an increased risk of ΔNIHSS ≥ + 2. Logistic regression confirmed that lower mean SBP ( p = 0.004), maximum SBP ( p = 0.001), SD ( p = 0.026), CV ( p = 0.021), and ARV ( p = 0.018) were significantly associated with NIHSS≤7. Conversely, higher mean SBP ( p = 0.03), max SBP ( p = 0.016), SD ( p = 0.017), CV ( p = 0.014), ARV ( p = 0.008), and |∆SBP| ≥ 10 mmHg frequency ( p = 0.045) independently was correlated with ΔNIHSS≥ + 2. No correlation was found between BP and HT. Subgroup analyses revealed that stroke location modified the effect of ARV on NIHSS≤7 ( p = 0.007) and mean SBP on ΔNIHSS≥ + 2 ( p = 0.024). Conclusion Higher post-EVT SBP levels and greater SBP variability were associated with reduced early recovery and an increased risk of neurological deterioration in ICAS-LVOS. Blood pressure should be maintained at a relatively low, consistent level.