Pretreatment collateral circulation status modifies the effect of blood pressure trajectory on outcome after endovascular therapy

Background and purpose: Blood pressure (BP) management in the acute phage of stroke is associated with clinical outcomes among patients with after endovascular therapy (EVT). This study was to explore whether collateral circulation status modified the effect of BP course on clinical outcomes in patients with EVT. Methods: This study enrolled a total of 800 patients with ischemic stroke caused by large-vessel occlusion in the anterior circulation who underwent successful recanalization. Latent mixture modeling was used to determine systolic BP (SBP) trajectories according to 3 SBP measurements during the first 24 hours after EVT. Collateral status prior to EVT was assessed by digital subtracted angiography. Clinical outcomes including stroke disability (modified Rankin Scale 3-6), mortality, and symptomatic intracranial hemorrhage (sICH) were collected 90 days after stroke. Results: Three SBP trajectories were identified: high (7%), moderate 57.9%, and low (35.1%) SBP. SBP trajectories were independently associated with unfavorable 90-d outcome ( P =0.012) after adjustment. Patients with high and moderate SBP trajectories had had an elevated risk of unfavorable outcome in the poor collateral (adjusted odds ratio, 6.19 [95%CI, 2.17-17.67], P <0.001 and adjusted odds ratio, 2.10 [95%CI, 1.23-3.57], P =0.007, respectively) rather than good collateral ( P for interaction: 0.042). There was no significant difference regarding mortality and sICH across SBP trajectories. Conclusions: Patients with high or moderate SBP trajectory during the first 24 hours after successful recanalization had a higher risk of unfavorable outcome among patients with poor collateral. Registration: https://www.clinicaltrials.gov/ct2/show/NCT04775147; https://www.clinicaltrials.gov/ct2/show/NCT04230785 Unique identifier: NCT04775147 (registered on March 01, 2021) and NCT04230785 (registered on January18, 2020).