ORIGINAL RESEARCH article
Front. Neurol.
Sec. Stroke
Impact of Blood Pressure Levels and Variability After Successful Revascularization on the prognosis in ICAS-LVOS Patients
Yimeng Liu
Hui Zhang
Qiang Dong
Wenjie Cao
Huashan Hospital, Fudan University, Shanghai, China
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Abstract
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 hours post-EVT. BPV metrics included standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and fluctuation frequency (|∆SBP|≥10mmHg). Outcomes included early favorable prognosis [National Institutes of Health Stroke Scale (NIHSS) ≤7], early neurological deterioration (NIHSS ≥ +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|≥10mmHg 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). Conclusions: 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.
Summary
Keywords
blood pressure variability, endovascular treatment, Intracranial atherosclerotic stenosis, large-vessel occlusive stroke, prognosis, systolic blood pressure
Received
07 January 2026
Accepted
18 February 2026
Copyright
© 2026 Liu, Zhang, Dong and Cao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Wenjie Cao
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