Effect of Blood Pressure Variability on Outcomes After Embolization of Brain Arteriovenous Malformation

Background and Purpose Blood pressure management after brain arteriovenous malformations (bAVMs) embolization lacks evidence-based guidelines. While mean blood pressure levels have been studied, the impact of blood pressure variability (BPV) on post-embolization outcomes remains unexplored. To evaluate the association of BPV and adverse outcomes after bAVMs embolization. Methods We conducted a retrospective cohort study of 108 patients undergoing bAVMs embolization at a single center (2022–2025). Four systolic BPV metrics were calculated during hospitalization: coefficient of variation, standard deviation, successive variation and average real variability.The primary composite outcome included functional deterioration (discharge modified Rankin Scale score > baseline admission score) and symptomatic intracranial hemorrhage (sICH). Multivariate logistic regression assessed independent predictors. Results Adverse outcomes occurred in 20 patients (18.5%). All systolic BPV metrics independently predicted adverse outcomes with odds ratios ranging 1.195–1.277 (all p ≤ 0.023). Coefficient of variation showed the strongest association (OR:1.277, 95%CI:1.044–1.564, p = 0.018), followed by average real variability (OR:1.237, 95%CI:1.035–1.478, p = 0.019) and standard deviation (OR:1.221, 95%CI:1.027–1.450, p = 0.023). ROC analysis demonstrated moderate discriminatory power (AUC 0.64–0.66), with SVR and ARV showing the highest performance (AUC = 0.66). Conclusions Larger BPV during hospitalization were associated with an increased risk of adverse outcomes after embolization of bAVMs, independent of mean BP. These findings support integrating BPV monitoring into post-embolization management protocols and warrant prospective validation.