Blood Pressure in the First 6 Hours for Older Adults with Stroke after Endovascular therapy: A Pooled Analysis of the DEVT and RESCUE BT Randomized Clinical Trials

Blood Pressure in the First 6 Hours for Older Adults with Stroke after Endovascular therapy: A Pooled Analysis of the DEVT and RESCUE BT Randomized Clinical Trials | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Blood Pressure in the First 6 Hours for Older Adults with Stroke after Endovascular therapy: A Pooled Analysis of the DEVT and RESCUE BT Randomized Clinical Trials Cheng Ma, Jingfan Li, Xinyue Zheng, Qiangqiang Zhang, Chong Zhang, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7033548/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Sep, 2025 Read the published version in Journal of Thrombosis and Thrombolysis → Version 1 posted You are reading this latest preprint version Abstract Background Optimal systolic blood pressure (SBP) targets after endovascular therapy (EVT) for stroke in older adults (≥ 65 years) remain undefined. This study assessed age-stratified associations between early post-EVT SBP (first 6 hours) and outcomes. Methods Post hoc analysis of two trials. Patients were stratified by age (18–64 vs. ≥65 years) and SBP (≤ 120, 120–140, > 140 mmHg). Primary outcome was 90-day functional status (modified Rankin Scale, mRS). Inverse probability treatment weighting (IPTW) and multivariable regression adjusted for confounders. Results Post-EVT SBP data were available for 267 young and 395 old patients. IPTW analysis revealed that sustained SBP below 120 mmHg during the first 6 hours post-EVT significantly enhanced functional independence in elderly patients (common OR: 2.00; 95% CI: 1.18–3.39). Among young cohorts, maintenance of SBP ≤ 120 mmHg (cOR, 2.89; 95% CI, 1.45–5.82) and 120–140 mmHg (cOR, 3.18; 95% CI, 1.58–6.47) were associated with a better outcome. sICH incidence demonstrated no statistically significant association with systolic blood pressure (SBP) levels ( P = 0.21; 95% CI: 0.93–1.35). Conclusions During the initial 6-hour window post- EVT, younger patients achieving SBP levels ≤ 140 mmHg and elderly patients maintaining SBP ≤ 120 mmHg demonstrated significantly improved clinical outcomes. These results suggest that stricter blood pressure control may be particularly beneficial for older adults in the early post-EVT phase. The DEVT registration: URL: http://www.chictr.org.cn; Chinese Clinical Trial Registry: ChiCTR-IOR-17013568, and the RESCUE BT registration: URL: http://www.chictr.org.cn; ChiCTR-INR-17014167. systolic blood pressure age endovascular therapy clinical prognoses Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Endovascular therapy (EVT) has been reported to significantly increase the recanalization rate and improve patients’ functional outcomes with large artery occlusion. Despite this, fewer half-patients achieved functional independence in the recanalization cohorts. 1 Ischemic-reperfusion injury was among the most critical problems, causing cerebral edema and intracranial hemorrhage as a result of disrupted blood-brain barriers. 2 Observational data indicate that elevated systolic blood pressure (SBP) in patients undergoing endovascular therapy (EVT) for large-artery occlusion is linked to adverse outcomes 2 – 7 , including increased mortality 2 , 6 , 7 , poorer functional recovery, and higher rates of symptomatic intracranial hemorrhage (sICH) 2 , 6 – 8 . The ENCHANTED2/MT trial further highlighted that maintaining SBP below 120 mmHg for 72 hours may elevate the risk of unfavorable outcomes compared to patients with SBP levels of 140–180 mmHg. 9 In contrast, the BP-TARGET trial found no significant differences in clinical outcomes between intensive (100–129 mmHg) and standard (130–180 mmHg) SBP targets within 24 hours post-randomization 10 . Collectively, the optimum level of post-EVT SBP control remains unknown. Substantial evidence has suggested that post-SBP management might need to be individualized and take other factors into accounts, such as recanalization status 7 , 11 , 12 , collateral circulation 12 , 13 , and age 14 – 16 . Low SBP might be associated with improved functional outcomes in the elderly even achieving successful recanalization, 16 which might be due to the poor collateral status 13 . Besides, impaired autoregulation of cerebral flow 17 also could increase the risk of poor prognoses in old patients. In young and older cohorts receiving EVT, the association between SBP level and the clinical prognosis is not well investigated. To address this knowledge gap, our study aimed to assess age-stratified associations between post-EVT SBP within the first 6 hours and functional recovery, as well as sICH risk. Methods Study Protocol Our study examined patients who underwent EVT due to anterior circulation occlusion. These patients were enrolled in two clinical trials, “Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients with Acute Ischemic Stroke (DEVT)” and “Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke (RESCUE BT)”. These are multicenter, randomized, double-blind trials conducted between May 20, 2018, and October 31, 2022. The protocol design has already been described in detail, including inclusion and exclusion criteria. 18 , 19 Patients All eligible patients underwent EVT within 24 hours of symptom onset. Anterior circulation occlusions, including the intracranial internal carotid artery or the M1/M2 segments of the middle cerebral artery, were confirmed via computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA). Patient demographics and clinical characteristics, such as age, sex, medical history, National Institutes of Health Stroke Scale (NIHSS) scores, and Alberta Stroke Program Early CT Score (ASPECTS), were collected. Collateral circulation was graded using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) system (levels 0–1, 2, and 3–4) 20 . Recanalization success was determined using the expanded Thrombolysis in Cerebral Infarction (eTICI) scale, with scores of 2b to 3 indicating successful recanalization 21 . Considering the age-related decline in cerebral autoregulation, vascular compliance, and collateral circulation in individuals aged 65 and above 22 , patients were stratified into two age groups: 18–64 years and ≥ 65 years. This classification aligns with the standards adopted by the World Health Organization (WHO) and major stroke trials such as ENCHANTED and INTERACT 23 , 24 . Systolic Blood Pressure (SBP) Measurement BP was measured within 6 hours after the end of EVT on the arm using a noninvasive monitoring device. At the local stroke centers, noninvasive blood pressure measurements were performed by nurses every 10 minutes. For each patient, six systolic blood pressure (SBP) readings were taken per hour (i.e., every 10 minutes) over a 6-hour period. Within each hour, the six readings were averaged to obtain the hourly mean SBP, resulting in six hourly mean values per patient. The average of these six hourly means was then calculated to represent the overall SBP during the 6-hour time window. Based on this value, patients were categorized into three groups: ≤120 mmHg, 120–140 mmHg, and > 140 mmHg, as previously reported. 25 , 26 Intracranial procedure-related hemorrhages could induce elevated SBP, thus, we excluded those cohorts to reduce the bias. Outcome Measures The primary endpoint was the modified Rankin Scale (mRS) score at 90 days, assessed independently by two blinded neurologists through video or voice recordings. The mRS is a 7-point scale ranging from 0 (no symptoms) to 6 (death). Secondary outcomes included favorable (mRS 0–2) and excellent (mRS 0–1) functional recovery at 90 days, 90-day mortality, and sICH. sICH was defined according to the Heidelberg Bleeding Classification 27 , requiring evidence of hemorrhage on non-contrast computed tomography within 48 hours accompanied by neurological deterioration (≥ 4 points on the NIHSS or ≥ 2 points in specific NIHSS subcategories). Statistical Analysis We used SPSS version 26 (IBM Corp., Armonk, New York, United States) and Stata version14 (StataCorp LLC, College Station, Texas, United States) for our statistical analyses. Statistical significance was defined as a p -value of less than 0.05 (two-tailed). Continuous variables are described using the median and interquartile range (IQR) and categorical variables as percentages. Comparing the difference in baseline characteristics, the Kruskal-Wallis test is applied to continuous variables, and the chi-square test or Fisher’s exact test is utilized for categorical variables. The Bonferroni test was applied to multiple comparisons. Missing baseline variables and clinical outcomes were not imputed due to low missing rates (sICH, 0.2% and eTICI, 0.3%). For the primary outcome, the common odds ratio for a shift towards a 1-point improvement in mRS was calculated using an ordinal regression model. The binary outcome was estimated using univariable and multivariable regression analyses. We stratified the patients’ characteristics into dichotomized age (≥ 65 vs. <65 years) and SBP groups. The effect of age on SBP management was estimated using trichotomized SBP, dichotomized age, and an interaction term between these variables. The following three models were used: (i) simple model with and without interaction; (ii) adjusted model using hypertension, baseline NIHSS, baseline ASPECTS, and successful recanalization as covariates; (iii) weighted model, using inverse probability of treatment weights (IPTW) to reduce the baseline imbalances between SBP groups. If an interaction term was found, a stratified model was used to assess the association between SBP and clinical outcomes. Furthermore, to assess the association between SBP and outcome in patients of different ages, stroke etiology, baseline NIHSS score, and baseline ASPECTS were considered covariates in younger people, and etiology of stroke, baseline NIHSS, baseline ASPECTS, and successful recanalization were adjusted in the elderly. For sensitivity purposes, we also explored the relationship between SBP and clinical prognosis in cohorts with successful recanalization. Percentage bar plots were used to reflect the distribution of mRS at 90 days. Curve percentages of favorable outcomes were described to show the change in mean SBP and to construct the optimal linear or nonlinear model as categorical variables ( 160 mm Hg). Besides, to analyze nonlinearly, we calculated the common odds ratios (cOR) with 95% CI per 10 mmHg increase SBP with the mRS using 131–140 mmHg as the reference. Result Baseline Characteristics A total of 662 patients with SBP measurements 6 h after EVT were eligible for analysis in Fig. 1 . Among these patients, 267 were aged 18–64 years and 395 were aged ≥ 65 years. The median baseline NIHSS score was 16 (IQR, 12–19) and 56.34% (n = 373) were male. Besides, the median SBP was 139 mmHg. Patients aged ≥ 65 years were predominantly female (67.42% vs. 48.86%; p < 0.001) and had a high median NIHSS score (16 vs. 14; p < 0.001) compared with younger patients (Table 1 ). Older patients had a high probability of having a history of pre-stroke, hypertension, atrial fibrillation, and poor collateral circulation compared with younger patients. Processed parameters, such as onset to recanalization time, were shorter in the elderly, but the successful recanalization odds were comparable. Figure 2 shows the distribution of the SBP group based on different ages. Further, the detailed information of the SBP group stratified by age is shown in Supplementary Table S1 . Table 1 Patient’s characteristics stratified by age 18–64 years (n = 267) ≥ 65 years (n = 395) P value Patient’s characteristic Male, n (%) 180(67.42) 193(48.86) < 0.001 Admission NIHSS, median [IQR] 14(10–18) 16(13–20) < 0.001 ASPECTS, median [IQR] 8(7–9) 8(7–9) 0.28 IVT, n (%) 23(8.61) 36(9.11) 0.83 Medical history, n (%) Pre-stroke 29(10.86) 70(17.72) 0.02 Atrial fibrillation 59(22.10) 167(42.28) < 0.001 Hypertension 110(41.20) 245(62.03) < 0.001 Diabetes 44(16.48) 86(21.77) 0.09 ASITN/SIR, grade, n (%) 0.02 0–1 69(25.84) 133(33.67) 2 117(43.82) 177(44.81) 3–4 81(30.34) 85(21.52) Stroke etiology, n (%) < 0.001 Cardioembolism 93(34.83) 201(50.89) Large artery atherosclerosis 138(51.69) 153(38.73) unknown 20(7.49) 37(9.37) Other 16(5.99) 4(1.01) Procedure Onset to recanalization time, min, median [IQR] 510.00(330.00-780.00) 431.00(297.00-639.00) 0.001 Successful recanalization, n (%) 249(93.61) 369(93.65) 0.98 SBP, mmHg, median [IQR] Admission SBP 139(121–156) 148(132–164) < 0.001 SBP max 135(125–151) 141(130–154) 0.003 SBP min 110(101–120) 109(101–120) 0.77 SBP mean 122(113–131) 124(116–134) 0.15 SBP grade, n (%) 0.14 SBP ≤ 120 117(43.82) 143(36.20) SBP 120–140 113(42.32) 187(47.34) SBP > 140 37(13.86) 65(16.46) SBP: Systolic blood pressure, IQR: Interquartile range, ASITN: American Society of Interventional and Therapeutic Neuroradiology, SIR: Society of Interventional Radiology, IVT: Intravenous thrombolysis, NIHSS: National Institutes of Health Stroke Scale, ASPECTS: Alberta Stroke Program Early CT Score The Association Between SBP and Outcomes Stratified by Age Primary Outcome In Table 2 , older adults frequently show an increased mRS score during the following 90 days (common odds ratio [cOR], 0.37; 95% confidence interval [CI], 0.28–0.49) than younger patients. Patients with SBP levels ≤ 120 mmHg or 120–140 mmHg showed significantly better clinical outcomes compared to those with SBP > 140 mmHg. There was an interaction between age and SBP groups ( p = 0.046 for primary outcome) in the simple model. Regarding younger patients, SBP ≤ 120 mmHg (cOR, 2.89; 95% CI, 1.44–5.78) or 120–140 mmHg (cOR, 3.18; 95% CI, 1.58–6.42) was significantly associated with a better outcome. SBP ≤ 120 mmHg (cOR, 2.00; 95% CI, 1.18–3.38) showed a statistically significant trend toward a low mRS score in the elderly. However, the interaction between age and SBP failed to be observed in the adjusted model ( p = 0.11 for interaction) and IPTW model ( p = 0.07 for interaction). Table 2 Association of systolic blood pressure groups with primary outcome stratified by age Model Odds ratio (95% confidence interval) P for interaction Age 18–64 vs. ≥ 65 years 0.37(0.28–0.49) NA SBP: ≤ 120 mmHg 2.44(1.62–3.69) NA 120–140 mmHg 1.74(1.16–2.60) NA > 140 mmHg Reference NA 18–64 years ≥ 65 years Simple model SBP: ≤ 120 mmHg 2.89(1.44–5.78) 2.00(1.18–3.38) 120–140 mmHg 3.18(1.58–6.42) 1.25(0.76–2.05) > 140 mmHg Reference Reference 0.046 Adjusted model SBP: ≤ 120 mmHg 3.05(1.48–6.31) 2.15(1.23–3.75) 120–140 mmHg 3.07(1.50–6.31) 1.33(0.79–2.21) > 140 mmHg Reference Reference 0.10 IPTW model SBP: ≤ 120 mmHg 2.89(1.45–5.82) 2.00(1.18–3.39) 120–140 mmHg 3.18(1.58–6.47) 1.25(0.76–2.05) > 140 mmHg Reference Reference 0.07 Adjusted model includes sex, hypertension, diabetes, stroke etiology, NIHSS, ASPECTS, ASITN/SIR grade, and onset to recanalization as adjusting factors; IPTW model includes sex, hypertension, diabetes, prestroke, NIHSS, ASPECTS, ASITN/SIR grade, stroke etiology, and onset to recanalization time as weighting factors. IPTW: Inverse probability of treatment weighting, SBP: Systolic blood pressure, OR: Odds ratio, NA: Not applicable, CI: Confidence interval, ASITN: American Society of Interventional and Therapeutic Neuroradiology, SIR: Society of Interventional Radiology, NIHSS: National Institutes of Health Stroke Scale, ASPECTS: Alberta Stroke Program Early CT Score Secondary Outcome Figures 3 A and 4 A show the distribution of functional outcomes in the SBP groups among younger patients. IPTW analysis demonstrated that patients with SBP ≤ 120 mmHg (OR: 2.15; 95% CI: 1.03–4.62) and 120–140 mmHg (OR: 2.79; 95% CI: 1.31–6.04) had significantly higher odds of favorable outcomes compared to those with SBP > 140 mmHg (Table 3 ). Mortality rates were also elevated in the SBP > 140 mmHg group relative to lower SBP categories. However, no significant differences in sICH rates were observed across SBP subgroups (5.13% vs. 2.56% vs. 13.51% for ≤ 120 mmHg, 120–140 mmHg, and > 140 mmHg, respectively; p = 0.07). Subgroup analysis further indicated that the SBP ≤ 140 mmHg group exhibited a higher likelihood of favorable outcomes (Fig. 4 C) and reduced mortality rates (Table S2 in supplement). Table 3 Comparing secondary outcomes in systolic blood pressure groups stratified by age 18–64 years(n = 267) ≥ 65 years(n = 395) Outcomes SBP groups Odds ratio (95% confidence interval) Odds ratio (95% confidence interval) Simple model Adjusted model IPTW model Simple model Adjusted model IPTW model mRS 0–2 ≤ 120 mmHg 2.03(0.96–4.28) 2.39(1.05–5.45) 2.39(1.14–5.11) 2.10(1.13–3.90) 2.03(1.02–4.04) 2.01(1.09–3.84) 120–140 mmHg 2.32(1.09–4.94) 2.55(1.11–5.87) 3.11(1.48–6.71) 1.26(0.69–2.30) 1.13(0.58–2.20) 1.24(0.68–2.33) > 140 mmHg Reference Reference Reference Reference Reference Reference mRS 0–1 ≤ 120 mmHg 1.98(0.91–4.31) 2.31(0.99–5.40) 1.96(0.92–4.39) 2.22(1.10–4.45) 2.24(1.04–4.83) 2.00(1.01–4.16) 120–140 mmHg 2.12(0.97–4.63) 2.21(0.95–5.15) 2.18(1.02–4.88) 1.23(0.61–2.47) 1.13(0.53–2.41) 1.15(0.58–2.38) > 140 mmHg Reference Reference Reference Reference Reference Reference Mortality ≤ 120 mmHg 0.15(0.06–0.41) 0.11(0.04–0.34) 0.17(0.06–0.47) 0.63(0.31–1.26) 0.62(0.29–1.32) 0.61(0.31–1.22) 120–140 mmHg 0.16(0.06–0.43) 0.13(0.04–0.40) 0.20(0.07–0.54) 0.74(0.39–1.43) 0.80(0.39–1.65) 0.68(0.36–1.32) > 140 mmHg Reference Reference Reference Reference Reference Reference sICH ≤ 120 mmHg 0.35(0.10–1.21) 0.37(0.09–1.50) 0.37(0.09–1.56) 0.50(0.21–1.24) 0.46(0.18–1.21) 0.30(0.12–0.76) 120–140 mmHg 0.18(0.04–0.77) 0.21(0.05–1.03) 0.19(0.03–0.94) 0.55(0.24–1.28) 0.56(0.22–1.41) 0.48(0.22–1.09) > 140 mmHg Reference Reference Reference Reference Reference Reference Adjusted for NIHSS, ASPECTS, and etiology of stroke; and weighted for sex, hypertension, diabetes, prestroke, admission NIHSS, ASPECTS, ASITN/SIR grade, stroke etiology, onset to recanalization time in young patients, Adjusted for NIHSS, ASPECTS, etiology of stroke, and successful recanalization; and weighted for sex, hypertension, diabetes, prestroke, admission NIHSS, ASPECTS, ASITN/SIR grade, stroke etiology, onset to recanalization time in old patients. IPTW: Inverse probability of treatment weighting, mRS: Modified Rankin Scale, sICH, Symptomatic intracranial hemorrhage, OR: Odds ratio, CI: Confidence interval, SBP: Systolic blood pressure, ASITN: American Society of Interventional and Therapeutic Neuroradiology, SIR: Society of Interventional Radiology, NIHSS: National Institutes of Health Stroke Scale, ASPECTS: Alberta Stroke Program Early CT Score Additionally, compared to individuals with SBP above 140 mmHg, the association between SBP > 120 mmHg (IPTW OR, 2.01; 95% CI, 1.09–3.84 in Table 3 ) and favorable outcomes was significant, whereas the association of SBP 120–140 mmHg and the favorable outcome was not significantly in older adults (Fig. 3 B and 4 B). Moreover, dichotomized SBP (SBP ≤ 120 mmHg vs. SBP > 120 mmHg) and patients with SBP > 120 mmHg were also associated with decreased odds of achieving better outcomes (IPTW cOR, 0.65; 95% CI, 0.45–0.94) (Fig. 4 D and Table S2 in supplement). A higher proportion of patients in the SBP ≤ 120 mmHg group had excellent outcomes compared with the > 120 mmHg group. Sensitivity Analyses In patients who underwent successful recanalization (as detailed in Supplemental Tables S3 and S4), those with SBP) ≤ 140 mmHg exhibited significantly higher odds of achieving favorable functional outcomes and a reduced risk of mortality in younger individuals. Furthermore, among older patients, maintaining SBP at or below 120 mmHg was associated with a greater probability of improved clinical outcomes compared to those with SBP levels exceeding 120 mmHg. These findings highlight the importance of tailored blood pressure management strategies based on age-specific thresholds to optimize post-recanalization prognosis. To further analyze the relationship between SBP and clinical outcomes in the early postoperative period, we performed stratified sensitivity analyses of SBP in units of 10 mmHg and plotted its trend in different age groups, respectively (Fig. 4 ). In elderly patients (Fig. 4 B, 4 D), the relationship between SBP levels and prognosis showed a clear dose-response trend: the highest proportion of good functional outcomes was achieved with SBP in the 100–120 mmHg interval, and the proportion of poor outcomes was significantly increased with SBP > 140 mmHg. the proportion of poor outcomes was significantly increased with SBP in the 100–120 mmHg interval had generally higher ORs than in the reference group (130–140 mmHg). In younger patients (Fig. 4 A, 4 C), the proportion of good versus poor outcomes varied less between SBP subgroups, with a flatter trend in the SBP 100–140 mmHg range. Although adverse outcomes increased at SBP > 140 mmHg, SBP did not show a significant difference in the comparison between ≤ 120 mmHg and 120–140 mmHg. Discussion Our findings provide evidence for an association between lower SBP in the first 6 h after EVT and functional independence at 90 days in patients with large-artery occlusion. Notably, SBP ≤ 140 mmHg in young patients and SBP ≤ 120 mmHg in older patients increased the probability of achieving favorable outcomes. Elevated post-EVT SBP has been shown to be correlated with worse outcomes. 2 , 4 , 5 In a post hoc analysis of the ENCHANTE trial, which evaluated intensive blood pressure reduction combined with intravenous thrombolysis for acute ischemic stroke, maintaining SBP below 140 mmHg over 24 hours was linked to more favorable functional outcomes. 28 And, the subgroup analysis of ENCHANTED2/MT also suggested among patients age younger than 65 years could get benefit from less intensive treatment. 9 Moreover, the goals of SBP after EVT were < 140 mmHg, which is applied in clinical practice, 29 , 30 such as the Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct (DAWN) trial. 31 Likewise, our findings also indicated that patients could benefit from controlling lower SBP within the first 6 h after EVT. A plausible explanation is that ischemic brain tissue is vulnerable to hyper-perfusion injury, including blood–brain barrier disruption, cerebral edema, and hemorrhage. 2 Thus, the ischemic section needs to maintain low or middle perfusion in the early reperfusion phase. Moreover, the findings aligned with the investigation of the link between low SBP and functional outcomes in successful recanalization groups in our study (sensitivity analysis). Conversely, the BP-TARGET trial showed that intensive SBP (100–129 mmHg) failed to reduce the odds of worse outcomes in patients with successful recanalization compared with the standard guidelines (130–185 mmHg). 10 High crossover rates (33.34% within 24 h) and tandem lesions (25%) were found in this study, which might explain the discrepancy. Moreover, in this study, the interaction between age and SBP group showed fluctuating significance across the simple, adjusted, and IPTW models (P = 0.046–0.10). Notably, the consistent direction of the interaction effect across models suggests a potentially meaningful clinical trend, which warrants further validation in future studies with larger sample sizes and improved confounding control (Table 2 ). Furthermore, despite intensive SBP management, the prognosis of patients post-EVT with functional independence are still uncertain. Recent studies have suggested that individualized SBP strategies are crucial in patients receiving EVT based on recanalization status 7 , 11 , 12 , 32 , collateral circulation 12 , 13 , and age 14 – 16 . Moreover, the findings of our study showed that the elderly could benefit from maintaining post-SBP < 120 mmHg during the initial 6 hours after EVT. Maintaining low SBP after admission was associated with decreased odds of worse prognoses in older cohorts. 16 Subgroup analysis of the A Registration Study for Critical Care of Acute Ischemic Stroke after Recanalization (RESCUE-RE) registry, based on collateral states, explored the correlation between SBP parameters and clinical outcomes in patients undergoing EVT for large-artery occlusion. 13 Under conditions of poor collateral states, the probability of worse outcomes was lower in patients with SBP 140 mmHg (OR, 4.2; 95% CI, 1.66–10.97). Older patients were observed to have weaker collaterals (ASITN/SIR grade 3–4, 21.52% versus 30.34%, p = 0.002) than younger patients, which was in line with previous reports. 33 , 34 Poor collaterals were commonly associated with large cerebral infarcts, 35 , 36 severe neurological deficits, 37 and worse functional outcome 38 , 39 . Notably, high reperfusion may exacerbate cerebral edema and increase the volume of cerebral infarction in patients with severe ischemic stroke. Additionally, hypertension (47.4% vs. 69.8%, p 120 mmHg. Chronic hypertension was considered to impair the autoregulation of cerebral flow. 17 The autoregulation system failed to alleviate cerebral edema in the vulnerable penumbral region in patients with hyper-reperfusion, 40 , 41 which could increase the risk of poor outcomes. In contrast, the ENCHANTED2/MT trial suggested that SBP less than 120 mmHg caused poor clinical prognosis than the SBP 140–180 mmHg group. 9 The difference could be due to long duration of insufficient reperfusion (72 h). Prolonged hypotension could get more chance to attenuate ischemia-reperfusion injury but exacerbate hypoperfusion, which is paradoxical for patients with ischemic stroke. A randomized controlled clinical trial is needed to identify the time range of maintaining low SBP in patients receiving EVT due to large artery occlusion. Besides, 110 patients who were identified with posterior circulation ischemic stroke were also included in the ENCHANTED2/MT trial, and these patients (OR,1.38; 95% CI, 1.02–1.88) can benefit from less intensive treatment. Indeed, the compensatory collaterals were poorer in the posterior than anterior circulation. The exclusive enrollment of anterior large vessel occlusion patients in our study may explain the observed discrepancy. Several investigations have indicated an association between high SBP and intracranial hemorrhage (ICH). According to the ENCHANTED trial, intensive BP lowering (< 140 mmHg) reduced the risk of any ICH, with a numerical but non-significant advantage in sICH, consistent with our findings. Although sICH did not differ significantly across SBP groups in our study, patients with SBP > 140 mmHg showed a higher tendency, highlighting the need for caution regarding postoperative hypertension. 23 Lower odds of sICH were reported to be correlated with SBP < 120 mmHg in a real-world study. 29 In contrast, post hoc analyses and randomized clinical trials have shown that SBP less than 180 mmHg was safe to reduce the sICH incidence in acute ischemic stroke patients. 10 , 42 Our results also did not reveal a difference in sICH between the SBP groups ( 140 mmHg) in the younger and older cohorts. In our study, only two patients had a mean SBP > 180 mmHg. Several constraints in this study need to be acknowledged. Initially, we performed a post hoc analysis and although we adjusted the variation and used IPTW analysis to minimize any bias, the possibility of residual and unmeasured confounding remains. Moreover, not all patients who participated in the two clinical trials were enrolled because SBP data were missing from some stroke centers, particularly with SBP during 6 to 24 hours after EVT. Second, the protocol of the RESCUE BT trial was designed to include patients with ASPECTS ≥ 6, which has the limitation of generalizability in patients with acute ischemic stroke. Third, noninvasive monitoring could expose patients to obscure detailed fluctuations in SBP. Regrettably, the final infarct volume and edema, which are known effectors of functional outcomes, were not available. Fourth, given that this study was a post hoc analysis based on two randomized controlled trials, neither of which recorded detailed information on the types or administration routes of antihypertensive medications, it is possible that some patients received different antihypertensive agents or blood pressure management strategies. Moreover, this study did not analyze blood pressure variability, which may have independent prognostic value in stroke outcomes. Therefore, we cannot completely rule out the potential influence of these unmeasured variables on the study results. In conclusion, caution should be exercised when applying the findings of this study. Considering these limitations, further validation through randomized controlled trials is required to confirm our findings, ideally with study designs that incorporate individualized blood pressure management strategies tailored to stroke etiology. Conclusion The findings highlight that targeting systolic blood pressure at or below 140 mmHg could enhance clinical results and reduce fatality rates in younger individuals. Conversely, maintaining SBP at 120 mmHg or lower was linked to improved functional independence in older patients during the initial six hours following endovascular therapy. Nonstandard Abbreviations and Acronyms Endovascular therapy (EVT); systolic blood pressure (SBP); inverse probability of treatment weighting (IPTW); symptomatic intracranial hemorrhage (sICH). Declarations Acknowledgements We are grateful for the dedication of all the coinvestigators of DEVT and RESCUE BT to the study. Funding/Support: The study is funded by the Clinical Medical Research Talent Training Program (2018XLC1005), and National Outstanding Youth Foundation (81525008). Conflict of Interest Disclosures: No potential conflict of interest relevant to this article was reported. Consent to Participate, Patients ’ consent form, Ethical Approval and/or Institutional Review Board (IRB) Approval ： The trial was approved by the China Ethics Committee of Registering Clinical Trials. The approval details are as follows: DEVT (Approval No. ChiECRCT-20170101, approved on December 27, 2017) and RESCUE BT (Approval No. ChiECRCT-20180012, approved on February 8, 2018). And, informed consent from each patient and/or their legal surrogates was obtained in accordance with the Declaration of Helsinki. Data availability statement Data from the trial can be obtained from the corresponding author upon justified request. References Goyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731 Anadani M, Orabi MY, Alawieh A, Goyal N, Alexandrov AV, Petersen N, et al. Blood pressure and outcome after mechanical thrombectomy with successful revascularization. Stroke. 2019;50:2448-2454 Maier IL, Tsogkas I, Behme D, Bähr M, Knauth M, Psychogios M-N, et al. High systolic blood pressure after successful endovascular treatment affects early functional outcome in acute ischemic stroke. Cerebrovasc Dis. 2018;45:18-25 Mistry EA, Sucharew H, Mistry AM, Mehta T, Arora N, Starosciak AK, et al. Blood pressure after endovascular therapy for ischemic stroke (best): A multicenter prospective cohort study. Stroke. 2019;50:3449-3455 Goyal N, Tsivgoulis G, Pandhi A, Chang JJ, Dillard K, Ishfaq MF, et al. Blood pressure levels post mechanical thrombectomy and outcomes in large vessel occlusion strokes. Neurology. 2017;89:540-547 Malhotra K, Goyal N, Katsanos AH, Filippatou A, Mistry EA, Khatri P, et al. Association of blood pressure with outcomes in acute stroke thrombectomy. Hypertension. 2020;75:730-739 Matusevicius M, Cooray C, Bottai M, Mazya M, Tsivgoulis G, Nunes AP, et al. Blood pressure after endovascular thrombectomy: Modeling for outcomes based on recanalization status. Stroke. 2020;51:519-525 Mistry EA, Mistry AM, Nakawah MO, Khattar NK, Fortuny EM, Cruz AS, et al. Systolic blood pressure within 24 hours after thrombectomy for acute ischemic stroke correlates with outcome. J Am Heart Assoc. 2017;6 Yang P, Song L, Zhang Y, Zhang X, Chen X, Li Y, et al. Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (enchanted2/mt): A multicentre, open-label, blinded-endpoint, randomised controlled trial. Lancet. 2022;400:1585-1596 Mazighi M, Richard S, Lapergue B, Sibon I, Gory B, Berge J, et al. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (bp-target): A multicentre, open-label, randomised controlled trial. Lancet Neurol. 2021;20:265-274 Martins AI, Sargento-Freitas J, Silva F, Jesus-Ribeiro J, Correia I, Gomes JP, et al. Recanalization modulates association between blood pressure and functional outcome in acute ischemic stroke. Stroke. 2016;47:1571-1576 Huang X, Guo H, Yuan L, Cai Q, Zhang M, Zhang Y, et al. Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status. Ther Adv Neurol Disord. 2021;14:1756286421997383 Liu D, Nie X, Pan Y, Yan H, Pu Y, Wei Y, et al. Adverse outcomes associated with higher mean blood pressure and greater blood pressure variability immediately after successful embolectomy in those with acute ischemic stroke, and the influence of pretreatment collateral circulation status. J Am Heart Assoc. 2021;10:e019350 Castillo J, Leira R, García MM, Serena J, Blanco M, Dávalos A. Blood pressure decrease during the acute phase of ischemic stroke is associated with brain injury and poor stroke outcome. Stroke. 2004;35:520-526 Leira R, Millán M, Díez-Tejedor E, Blanco M, Serena J, Fuentes B, et al. Age determines the effects of blood pressure lowering during the acute phase of ischemic stroke: The tica study. Hypertension. 2009;54:769-774 Bager J-E, Hjalmarsson C, Manhem K, Andersson B. Acute blood pressure levels and long-term outcome in ischemic stroke. Brain Behav. 2018;8:e00992 Strandgaard S. Autoregulation of cerebral blood flow in hypertensive patients. The modifying influence of prolonged antihypertensive treatment on the tolerance to acute, drug-induced hypotension. Circulation. 1976;53:720-727 Zi W, Qiu Z, Li F, Sang H, Wu D, Luo W, et al. Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: The devt randomized clinical trial. JAMA. 2021;325:234-243 Qiu Z, Li F, Sang H, Luo W, Liu S, Liu W, et al. Effect of intravenous tirofiban vs placebo before endovascular thrombectomy on functional outcomes in large vessel occlusion stroke: The rescue bt randomized clinical trial. JAMA. 2022;328:543-553 Higashida RT, Furlan AJ, Roberts H, Tomsick T, Connors B, Barr J, et al. Trial design and reporting standards for intra-arterial cerebral thrombolysis for acute ischemic stroke. Stroke. 2003;34:e109-e137 Zaidat OO, Yoo AJ, Khatri P, Tomsick TA, von Kummer R, Saver JL, et al. Recommendations on angiographic revascularization grading standards for acute ischemic stroke: A consensus statement. Stroke. 2013;44:2650-2663 Zimmerman B, Rypma B, Gratton G, Fabiani M. Age-related changes in cerebrovascular health and their effects on neural function and cognition: A comprehensive review. Psychophysiology. 2021;58(7):e13796. Anderson CS, Huang Y, Lindley RI, et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet. 2019;393(10174):877-888. doi:10.1016/S0140-6736(19)30038-8 You S, Zheng D, Yoshimura S, et al. Optimum Baseline Clinical Severity Scale Cut Points for Prognosticating Intracerebral Hemorrhage: INTERACT Studies. Stroke. 2024;55(1):139-145. Samuels N, van de Graaf RA, van den Berg CAL, Uniken Venema SM, Bala K, van Doormaal PJ, et al. Blood pressure in the first 6 hours following endovascular treatment for ischemic stroke is associated with outcome. Stroke. 2021;52:3514-3522 Chu H-J, Lin C-H, Chen C-H, Hwang YT, Lee M, Lee C-W, et al. Effect of blood pressure parameters on functional independence in patients with acute ischemic stroke in the first 6 hours after endovascular thrombectomy. J Neurointerv Surg. 2020;12:937-941 von Kummer R, Broderick JP, Campbell BCV, Demchuk A, Goyal M, Hill MD, et al. The heidelberg bleeding classification: Classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke. 2015;46:2981-2986 Wang X, Minhas JS, Moullaali TJ, Di Tanna GL, Lindley RI, Chen X, et al. Associations of early systolic blood pressure control and outcome after thrombolysis-eligible acute ischemic stroke: Results from the enchanted study. Stroke. 2022;53:779-787 Anadani M, Arthur AS, Tsivgoulis G, Simpson KN, Alawieh A, Orabi Y, et al. Blood pressure goals and clinical outcomes after successful endovascular therapy: A multicenter study. Ann Neurol. 2020;87:830-839 Mistry EA, Mayer SA, Khatri P. Blood pressure management after mechanical thrombectomy for acute ischemic stroke: A survey of the strokenet sites. J Stroke Cerebrovasc Dis. 2018;27:2474-2478 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2018;49 Hong L, Cheng X, Lin L, Bivard A, Ling Y, Butcher K, et al. The blood pressure paradox in acute ischemic stroke. Ann Neurol. 2019;85:331-339 Wiegers EJA, Mulder MJHL, Jansen IGH, Venema E, Compagne KCJ, Berkhemer OA, et al. Clinical and imaging determinants of collateral status in patients with acute ischemic stroke in mr clean trial and registry. Stroke. 2020;51:1493-1502 Brouwer J, Smaal JA, Emmer BJ, de Ridder IR, van den Wijngaard IR, de Leeuw F-E, et al. Endovascular thrombectomy in young patients with stroke: A mr clean registry study. Stroke. 2022;53:34-42 Fanou EM, Knight J, Aviv RI, Hojjat SP, Symons SP, Zhang L, et al. Effect of collaterals on clinical presentation, baseline imaging, complications, and outcome in acute stroke. AJNR Am J Neuroradiol. 2015;36:2285-2291 Lin L, Yang J, Chen C, Tian H, Bivard A, Spratt NJ, et al. Association of collateral status and ischemic core growth in patients with acute ischemic stroke. Neurology. 2021;96:e161-e170 Semerano A, Laredo C, Zhao Y, Rudilosso S, Renú A, Llull L, et al. Leukocytes, collateral circulation, and reperfusion in ischemic stroke patients treated with mechanical thrombectomy. Stroke. 2019;50:3456-3464 Leng X, Fang H, Leung TWH, Mao C, Xu Y, Miao Z, et al. Impact of collateral status on successful revascularization in endovascular treatment: A systematic review and meta-analysis. Cerebrovasc Dis. 2016;41:27-34 Leng X, Fang H, Leung TWH, Mao C, Miao Z, Liu L, et al. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016;87:537-544 Cole DJ, Matsumura JS, Drummond JC, Schell RM. Focal cerebral ischemia in rats: Effects of induced hypertension, during reperfusion, on cbf. J Cereb Blood Flow Metab. 1992;12:64-69 Kang B-T, Leoni RF, Kim D-E, Silva AC. Phenylephrine-induced hypertension during transient middle cerebral artery occlusion alleviates ischemic brain injury in spontaneously hypertensive rats. Brain Res. 2012;1477:83-91 Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2019;50:e344-e418 Additional Declarations No competing interests reported. Supplementary Files Supplementalmaterial.docx Cite Share Download PDF Status: Published Journal Publication published 04 Sep, 2025 Read the published version in Journal of Thrombosis and Thrombolysis → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7033548","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":486528821,"identity":"dcd35f20-6719-4e12-ada5-992dd7e5440e","order_by":0,"name":"Cheng Ma","email":"","orcid":"","institution":"Xianyang Hospital of Yan'an University","correspondingAuthor":false,"prefix":"","firstName":"Cheng","middleName":"","lastName":"Ma","suffix":""},{"id":486528822,"identity":"c9a723fa-5604-48f4-95e7-73067257838b","order_by":1,"name":"Jingfan Li","email":"","orcid":"","institution":"The First Hospital of Yulin and The Second Affiliated Hospital, Yanan University","correspondingAuthor":false,"prefix":"","firstName":"Jingfan","middleName":"","lastName":"Li","suffix":""},{"id":486528823,"identity":"0605ac44-9836-4b55-9471-180169d6b792","order_by":2,"name":"Xinyue Zheng","email":"","orcid":"","institution":"Xianyang Hospital of Yan'an University","correspondingAuthor":false,"prefix":"","firstName":"Xinyue","middleName":"","lastName":"Zheng","suffix":""},{"id":486528824,"identity":"ea1aded5-3f6e-44d4-894f-ec9bc1b06141","order_by":3,"name":"Qiangqiang Zhang","email":"","orcid":"","institution":"Xianyang Hospital of Yan'an University","correspondingAuthor":false,"prefix":"","firstName":"Qiangqiang","middleName":"","lastName":"Zhang","suffix":""},{"id":486528825,"identity":"0f5edfb4-23ac-46ed-b189-74ef825ebe30","order_by":4,"name":"Chong Zhang","email":"","orcid":"","institution":"Xianyang Hospital of Yan'an 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Wang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2UlEQVRIiWNgGAWjYBACAxCRwMDAw8/efPBBQkUN8VpkJHuOJRs8OHOMSC1AYGNwI8dM8mELM2Et5hLJzx48qLnDY3DmjFlFYgMbA397dwJeLZYz0swNEo4945E83lZ2I3GHDIPEmbMb8DvsRoKZRALbYR6+M4e33Ug8w8ZgIJFLSEv6N4mEf4d5GIB6CxLbmInRkmMmkdh2mEfgRooZA3Fazrwpk0jsO8wDCmSJhDPHeAj75Xj6Nskf3w7bg6Ly44+KGjn+9l78WjAAD2nKR8EoGAWjYBRgBQCHZk8Q2TMYqwAAAABJRU5ErkJggg==","orcid":"","institution":"Xianyang Hospital of Yan'an University","correspondingAuthor":true,"prefix":"","firstName":"Wenzhe","middleName":"","lastName":"Wang","suffix":""}],"badges":[],"createdAt":"2025-07-03 02:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7033548/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7033548/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11239-025-03178-z","type":"published","date":"2025-09-04T15:57:47+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":87266989,"identity":"fc5ce8e6-e2e4-4d4c-b79f-373c2a81aa8d","added_by":"auto","created_at":"2025-07-22 08:04:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":198157,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart for patient selection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRESCUE BT indicates The Endovascular Treatment With vs Without Tirofiban for Patients with Large Vessel Occlusion Stroke; DEVT, Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients With Acute Ischemic Stroke; SBP, systolic blood pressure; EVT, endovascular therapy.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7033548/v1/d74b9021713646ab23aa9c74.png"},{"id":87266987,"identity":"fe444866-3743-4144-87db-590c906ad4fa","added_by":"auto","created_at":"2025-07-22 08:04:33","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":115871,"visible":true,"origin":"","legend":"\u003cp\u003eThe distribution of systolic blood pressure in the first 6 hours following endovascular therapy in young (A), and old patients (B)\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7033548/v1/7bbc3a0f6f28aec9f92d1a17.png"},{"id":87266986,"identity":"80514e58-adb4-4fdc-b511-87de5fb50a6c","added_by":"auto","created_at":"2025-07-22 08:04:33","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":224994,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of the modified Rankin Scale (mRS) scores at 90 days in systolic blood pressure groups according to the stratified by young (A) and old age (B)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7033548/v1/c0a084f6b4fa4f8446f6ca3f.png"},{"id":87270530,"identity":"3525f87a-8039-4d84-8c76-924dd5986e89","added_by":"auto","created_at":"2025-07-22 08:20:33","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":218375,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAssociation of categorical systolic blood pressure and clinical outcomes\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e(A, B) Illustration of changes in rates of favorable outcome (poor outcome) by categorical systolic blood pressure (SBP) in young (A, R\u003csup\u003e2\u003c/sup\u003e=0.56) and old (B, R\u003csup\u003e2\u003c/sup\u003e=0.72) patients. (C, D) Commons Odds ratios (cOR) for mRS orders at 90 days and 95% CI were compared between different categorical SBP and the reference (131-140 mmHg). (C)Young patients with SBP 141-150 mmHg were associated with a low likelihood odds of improvement outcome comparing reference (cOR, 0.17; 95% CI, 0.06–0.50; \u003cem\u003ep\u003c/em\u003e for trend 0.07). (D) Old patients with SBP 110-120 mmHg had lower rates of mRS increase than the reference (cOR, 1.88; 95% CI, 1.07–3.30; \u003cem\u003ep\u003c/em\u003e for trend 0.87).\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7033548/v1/4d646f9aace2fde0b04bfc39.png"},{"id":90827974,"identity":"47e3f7d7-a581-4bbc-8a06-cb87e6c1e5c5","added_by":"auto","created_at":"2025-09-08 16:04:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1733416,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7033548/v1/1fc92918-dfe3-4ac0-bfab-69f3e655a801.pdf"},{"id":87268945,"identity":"d0759c62-a4d7-49c5-ab00-549c8b0f0764","added_by":"auto","created_at":"2025-07-22 08:12:33","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":34097,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementalmaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-7033548/v1/b9b54ffd2dc9528f60606ff4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Blood Pressure in the First 6 Hours for Older Adults with Stroke after Endovascular therapy: A Pooled Analysis of the DEVT and RESCUE BT Randomized Clinical Trials","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndovascular therapy (EVT) has been reported to significantly increase the recanalization rate and improve patients’ functional outcomes with large artery occlusion. Despite this, fewer half-patients achieved functional independence in the recanalization cohorts.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Ischemic-reperfusion injury was among the most critical problems, causing cerebral edema and intracranial hemorrhage as a result of disrupted blood-brain barriers.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eObservational data indicate that elevated systolic blood pressure (SBP) in patients undergoing endovascular therapy (EVT) for large-artery occlusion is linked to adverse outcomes\u003csup\u003e\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e–\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, including increased mortality\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e, poorer functional recovery, and higher rates of symptomatic intracranial hemorrhage (sICH)\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e–\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. The ENCHANTED2/MT trial further highlighted that maintaining SBP below 120 mmHg for 72 hours may elevate the risk of unfavorable outcomes compared to patients with SBP levels of 140–180 mmHg.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e In contrast, the BP-TARGET trial found no significant differences in clinical outcomes between intensive (100–129 mmHg) and standard (130–180 mmHg) SBP targets within 24 hours post-randomization\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Collectively, the optimum level of post-EVT SBP control remains unknown. Substantial evidence has suggested that post-SBP management might need to be individualized and take other factors into accounts, such as recanalization status\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, collateral circulation\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, and age\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eLow SBP might be associated with improved functional outcomes in the elderly even achieving successful recanalization,\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e which might be due to the poor collateral status\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Besides, impaired autoregulation of cerebral flow\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e also could increase the risk of poor prognoses in old patients. In young and older cohorts receiving EVT, the association between SBP level and the clinical prognosis is not well investigated. To address this knowledge gap, our study aimed to assess age-stratified associations between post-EVT SBP within the first 6 hours and functional recovery, as well as sICH risk.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cb\u003eStudy Protocol\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur study examined patients who underwent EVT due to anterior circulation occlusion. These patients were enrolled in two clinical trials, “Effect of Endovascular Treatment Alone vs Intravenous Alteplase Plus Endovascular Treatment on Functional Independence in Patients with Acute Ischemic Stroke (DEVT)” and “Effect of Intravenous Tirofiban vs Placebo Before Endovascular Thrombectomy on Functional Outcomes in Large Vessel Occlusion Stroke (RESCUE BT)”. These are multicenter, randomized, double-blind trials conducted between May 20, 2018, and October 31, 2022. The protocol design has already been described in detail, including inclusion and exclusion criteria.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatients\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll eligible patients underwent EVT within 24 hours of symptom onset. Anterior circulation occlusions, including the intracranial internal carotid artery or the M1/M2 segments of the middle cerebral artery, were confirmed via computed tomography angiography (CTA), magnetic resonance angiography (MRA), or digital subtraction angiography (DSA). Patient demographics and clinical characteristics, such as age, sex, medical history, National Institutes of Health Stroke Scale (NIHSS) scores, and Alberta Stroke Program Early CT Score (ASPECTS), were collected. Collateral circulation was graded using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) system (levels 0–1, 2, and 3–4) \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Recanalization success was determined using the expanded Thrombolysis in Cerebral Infarction (eTICI) scale, with scores of 2b to 3 indicating successful recanalization\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Considering the age-related decline in cerebral autoregulation, vascular compliance, and collateral circulation in individuals aged 65 and above\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e, patients were stratified into two age groups: 18–64 years and ≥ 65 years. This classification aligns with the standards adopted by the World Health Organization (WHO) and major stroke trials such as ENCHANTED and INTERACT\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSystolic Blood Pressure (SBP) Measurement\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBP was measured within 6 hours after the end of EVT on the arm using a noninvasive monitoring device. At the local stroke centers, noninvasive blood pressure measurements were performed by nurses every 10 minutes. For each patient, six systolic blood pressure (SBP) readings were taken per hour (i.e., every 10 minutes) over a 6-hour period. Within each hour, the six readings were averaged to obtain the hourly mean SBP, resulting in six hourly mean values per patient. The average of these six hourly means was then calculated to represent the overall SBP during the 6-hour time window. Based on this value, patients were categorized into three groups: ≤120 mmHg, 120–140 mmHg, and \u0026gt; 140 mmHg, as previously reported.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Intracranial procedure-related hemorrhages could induce elevated SBP, thus, we excluded those cohorts to reduce the bias.\u003c/p\u003e\u003cp\u003e\u003cb\u003eOutcome Measures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe primary endpoint was the modified Rankin Scale (mRS) score at 90 days, assessed independently by two blinded neurologists through video or voice recordings. The mRS is a 7-point scale ranging from 0 (no symptoms) to 6 (death). Secondary outcomes included favorable (mRS 0–2) and excellent (mRS 0–1) functional recovery at 90 days, 90-day mortality, and sICH. sICH was defined according to the Heidelberg Bleeding Classification\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e, requiring evidence of hemorrhage on non-contrast computed tomography within 48 hours accompanied by neurological deterioration (≥ 4 points on the NIHSS or ≥ 2 points in specific NIHSS subcategories).\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eWe used SPSS version 26 (IBM Corp., Armonk, New York, United States) and Stata version14 (StataCorp LLC, College Station, Texas, United States) for our statistical analyses. Statistical significance was defined as a \u003cem\u003ep\u003c/em\u003e-value of less than 0.05 (two-tailed). Continuous variables are described using the median and interquartile range (IQR) and categorical variables as percentages. Comparing the difference in baseline characteristics, the Kruskal-Wallis test is applied to continuous variables, and the chi-square test or Fisher’s exact test is utilized for categorical variables. The Bonferroni test was applied to multiple comparisons. Missing baseline variables and clinical outcomes were not imputed due to low missing rates (sICH, 0.2% and eTICI, 0.3%).\u003c/p\u003e\u003cp\u003eFor the primary outcome, the common odds ratio for a shift towards a 1-point improvement in mRS was calculated using an ordinal regression model. The binary outcome was estimated using univariable and multivariable regression analyses. We stratified the patients’ characteristics into dichotomized age (≥ 65 vs. \u0026lt;65 years) and SBP groups. The effect of age on SBP management was estimated using trichotomized SBP, dichotomized age, and an interaction term between these variables. The following three models were used: (i) simple model with and without interaction; (ii) adjusted model using hypertension, baseline NIHSS, baseline ASPECTS, and successful recanalization as covariates; (iii) weighted model, using inverse probability of treatment weights (IPTW) to reduce the baseline imbalances between SBP groups. If an interaction term was found, a stratified model was used to assess the association between SBP and clinical outcomes. Furthermore, to assess the association between SBP and outcome in patients of different ages, stroke etiology, baseline NIHSS score, and baseline ASPECTS were considered covariates in younger people, and etiology of stroke, baseline NIHSS, baseline ASPECTS, and successful recanalization were adjusted in the elderly. For sensitivity purposes, we also explored the relationship between SBP and clinical prognosis in cohorts with successful recanalization.\u003c/p\u003e\u003cp\u003ePercentage bar plots were used to reflect the distribution of mRS at 90 days. Curve percentages of favorable outcomes were described to show the change in mean SBP and to construct the optimal linear or nonlinear model as categorical variables (\u0026lt; 100, 100–120, 121–130, 131–140, 141–150, 151–160, and \u0026gt; 160 mm Hg). Besides, to analyze nonlinearly, we calculated the common odds ratios (cOR) with 95% CI per 10 mmHg increase SBP with the mRS using 131–140 mmHg as the reference.\u003c/p\u003e"},{"header":"Result","content":"\u003cp\u003e\u003cb\u003eBaseline Characteristics\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 662 patients with SBP measurements 6 h after EVT were eligible for analysis in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Among these patients, 267 were aged 18–64 years and 395 were aged ≥ 65 years. The median baseline NIHSS score was 16 (IQR, 12–19) and 56.34% (n = 373) were male. Besides, the median SBP was 139 mmHg. Patients aged ≥ 65 years were predominantly female (67.42% vs. 48.86%; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and had a high median NIHSS score (16 vs. 14; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) compared with younger patients (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Older patients had a high probability of having a history of pre-stroke, hypertension, atrial fibrillation, and poor collateral circulation compared with younger patients. Processed parameters, such as onset to recanalization time, were shorter in the elderly, but the successful recanalization odds were comparable. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the distribution of the SBP group based on different ages. Further, the detailed information of the SBP group stratified by age is shown in Supplementary Table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003eS1\u003c/span\u003e.\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePatient’s characteristics stratified by age\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18–64 years\u003c/p\u003e\u003cp\u003e(n = 267)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e≥ 65 years\u003c/p\u003e \u003cp\u003e(n = 395)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePatient’s characteristic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e180(67.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e193(48.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmission NIHSS, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14(10–18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16(13–20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASPECTS, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8(7–9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8(7–9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIVT, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e23(8.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36(9.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedical history, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePre-stroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e29(10.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70(17.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtrial fibrillation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e59(22.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e167(42.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHypertension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110(41.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e245(62.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e44(16.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e86(21.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.09\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASITN/SIR, grade, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0–1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e69(25.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e133(33.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e117(43.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e177(44.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3–4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81(30.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85(21.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStroke etiology, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCardioembolism\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e93(34.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e201(50.89)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLarge artery atherosclerosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138(51.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153(38.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunknown\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20(7.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(9.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16(5.99)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4(1.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProcedure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnset to recanalization time, min, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e510.00(330.00-780.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e431.00(297.00-639.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSuccessful recanalization, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e249(93.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e369(93.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.98\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP, mmHg, median [IQR]\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdmission SBP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e139(121–156)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e148(132–164)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP max\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e135(125–151)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e141(130–154)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP min\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e110(101–120)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e109(101–120)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP mean\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e122(113–131)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e124(116–134)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP grade, n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP ≤ 120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e117(43.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e143(36.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP 120–140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113(42.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e187(47.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSBP \u0026gt; 140\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37(13.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65(16.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eSBP: Systolic blood pressure, IQR: Interquartile range, ASITN: American Society of Interventional and Therapeutic Neuroradiology, SIR: Society of Interventional Radiology, IVT: Intravenous thrombolysis, NIHSS: National Institutes of Health Stroke Scale, ASPECTS: Alberta Stroke Program Early CT Score\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003cb\u003eThe Association Between SBP and Outcomes Stratified by Age\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003ePrimary Outcome\u003c/em\u003e\u003c/p\u003e\u003cp\u003eIn Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, older adults frequently show an increased mRS score during the following 90 days (common odds ratio [cOR], 0.37; 95% confidence interval [CI], 0.28–0.49) than younger patients. Patients with SBP levels ≤ 120 mmHg or 120–140 mmHg showed significantly better clinical outcomes compared to those with SBP \u0026gt; 140 mmHg. There was an interaction between age and SBP groups (\u003cem\u003ep\u003c/em\u003e = 0.046 for primary outcome) in the simple model. Regarding younger patients, SBP ≤ 120 mmHg (cOR, 2.89; 95% CI, 1.44–5.78) or 120–140 mmHg (cOR, 3.18; 95% CI, 1.58–6.42) was significantly associated with a better outcome. SBP ≤ 120 mmHg (cOR, 2.00; 95% CI, 1.18–3.38) showed a statistically significant trend toward a low mRS score in the elderly. However, the interaction between age and SBP failed to be observed in the adjusted model (\u003cem\u003ep\u003c/em\u003e = 0.11 for interaction) and IPTW model (\u003cem\u003ep\u003c/em\u003e = 0.07 for interaction).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eAssociation of systolic blood pressure groups with primary outcome stratified by age\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModel\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eOdds ratio (95% confidence interval)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e \u003csub\u003efor interaction\u003c/sub\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge 18–64 vs. ≥ 65 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.37(0.28–0.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSBP: ≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.44(1.62–3.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.74(1.16–2.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18–64 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e≥ 65 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSimple model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSBP: ≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.89(1.44–5.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.00(1.18–3.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.18(1.58–6.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.25(0.76–2.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.046\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAdjusted model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSBP: ≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.05(1.48–6.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.15(1.23–3.75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.07(1.50–6.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.33(0.79–2.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIPTW model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSBP: ≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.89(1.45–5.82)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.00(1.18–3.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.18(1.58–6.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.25(0.76–2.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.07\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eAdjusted model includes sex, hypertension, diabetes, stroke etiology, NIHSS, ASPECTS, ASITN/SIR grade, and onset to recanalization as adjusting factors; IPTW model includes sex, hypertension, diabetes, prestroke, NIHSS, ASPECTS, ASITN/SIR grade, stroke etiology, and onset to recanalization time as weighting factors.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eIPTW: Inverse probability of treatment weighting, SBP: Systolic blood pressure, OR: Odds ratio, NA: Not applicable, CI: Confidence interval, ASITN: American Society of Interventional and Therapeutic Neuroradiology, SIR: Society of Interventional Radiology, NIHSS: National Institutes of Health Stroke Scale, ASPECTS: Alberta Stroke Program Early CT Score\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e\u003cem\u003eSecondary Outcome\u003c/em\u003e\u003c/p\u003e\u003cp\u003eFigures \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA show the distribution of functional outcomes in the SBP groups among younger patients. IPTW analysis demonstrated that patients with SBP ≤ 120 mmHg (OR: 2.15; 95% CI: 1.03–4.62) and 120–140 mmHg (OR: 2.79; 95% CI: 1.31–6.04) had significantly higher odds of favorable outcomes compared to those with SBP \u0026gt; 140 mmHg (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Mortality rates were also elevated in the SBP \u0026gt; 140 mmHg group relative to lower SBP categories. However, no significant differences in sICH rates were observed across SBP subgroups (5.13% vs. 2.56% vs. 13.51% for ≤ 120 mmHg, 120–140 mmHg, and \u0026gt; 140 mmHg, respectively; \u003cem\u003ep\u003c/em\u003e = 0.07). Subgroup analysis further indicated that the SBP ≤ 140 mmHg group exhibited a higher likelihood of favorable outcomes (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC) and reduced mortality rates (Table S2 in supplement).\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparing secondary outcomes in systolic blood pressure groups stratified by age\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003e18–64 years(n = 267)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003e≥ 65 years(n = 395)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eOutcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eSBP groups\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e\u003cp\u003eOdds ratio (95% confidence interval)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e\u003cp\u003eOdds ratio (95% confidence interval)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSimple model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAdjusted model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eIPTW model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSimple model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eAdjusted model\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIPTW model\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emRS 0–2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.03(0.96–4.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.39(1.05–5.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.39(1.14–5.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.10(1.13–3.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.03(1.02–4.04)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.01(1.09–3.84)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.32(1.09–4.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.55(1.11–5.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.11(1.48–6.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.26(0.69–2.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.13(0.58–2.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.24(0.68–2.33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003emRS 0–1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.98(0.91–4.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.31(0.99–5.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.96(0.92–4.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.22(1.10–4.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e2.24(1.04–4.83)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2.00(1.01–4.16)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.12(0.97–4.63)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.21(0.95–5.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.18(1.02–4.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.23(0.61–2.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.13(0.53–2.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.15(0.58–2.38)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMortality\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.15(0.06–0.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.11(0.04–0.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.17(0.06–0.47)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.63(0.31–1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.62(0.29–1.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.61(0.31–1.22)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.16(0.06–0.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.13(0.04–0.40)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.20(0.07–0.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.74(0.39–1.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.80(0.39–1.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.68(0.36–1.32)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esICH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e≤ 120 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.35(0.10–1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.37(0.09–1.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.37(0.09–1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.50(0.21–1.24)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.46(0.18–1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.30(0.12–0.76)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e120–140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.18(0.04–0.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.21(0.05–1.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.19(0.03–0.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.55(0.24–1.28)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.56(0.22–1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.48(0.22–1.09)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt; 140 mmHg\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eAdjusted for NIHSS, ASPECTS, and etiology of stroke; and weighted for sex, hypertension, diabetes, prestroke, admission NIHSS, ASPECTS, ASITN/SIR grade, stroke etiology, onset to recanalization time in young patients, Adjusted for NIHSS, ASPECTS, etiology of stroke, and successful recanalization; and weighted for sex, hypertension, diabetes, prestroke, admission NIHSS, ASPECTS, ASITN/SIR grade, stroke etiology, onset to recanalization time in old patients.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eIPTW: Inverse probability of treatment weighting, mRS: Modified Rankin Scale, sICH, Symptomatic intracranial hemorrhage, OR: Odds ratio, CI: Confidence interval, SBP: Systolic blood pressure, ASITN: American Society of Interventional and Therapeutic Neuroradiology, SIR: Society of Interventional Radiology, NIHSS: National Institutes of Health Stroke Scale, ASPECTS: Alberta Stroke Program Early CT Score\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eAdditionally, compared to individuals with SBP above 140 mmHg, the association between SBP \u0026gt; 120 mmHg (IPTW OR, 2.01; 95% CI, 1.09–3.84 in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) and favorable outcomes was significant, whereas the association of SBP 120–140 mmHg and the favorable outcome was not significantly in older adults (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eB and \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB). Moreover, dichotomized SBP (SBP ≤ 120 mmHg vs. SBP \u0026gt; 120 mmHg) and patients with SBP \u0026gt; 120 mmHg were also associated with decreased odds of achieving better outcomes (IPTW cOR, 0.65; 95% CI, 0.45–0.94) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eD and Table S2 in supplement). A higher proportion of patients in the SBP ≤ 120 mmHg group had excellent outcomes compared with the \u0026gt; 120 mmHg group.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSensitivity Analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn patients who underwent successful recanalization (as detailed in Supplemental Tables S3 and S4), those with SBP) ≤ 140 mmHg exhibited significantly higher odds of achieving favorable functional outcomes and a reduced risk of mortality in younger individuals. Furthermore, among older patients, maintaining SBP at or below 120 mmHg was associated with a greater probability of improved clinical outcomes compared to those with SBP levels exceeding 120 mmHg. These findings highlight the importance of tailored blood pressure management strategies based on age-specific thresholds to optimize post-recanalization prognosis.\u003c/p\u003e\u003cp\u003eTo further analyze the relationship between SBP and clinical outcomes in the early postoperative period, we performed stratified sensitivity analyses of SBP in units of 10 mmHg and plotted its trend in different age groups, respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). In elderly patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eB, \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eD), the relationship between SBP levels and prognosis showed a clear dose-response trend: the highest proportion of good functional outcomes was achieved with SBP in the 100–120 mmHg interval, and the proportion of poor outcomes was significantly increased with SBP \u0026gt; 140 mmHg. the proportion of poor outcomes was significantly increased with SBP in the 100–120 mmHg interval had generally higher ORs than in the reference group (130–140 mmHg). In younger patients (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eA, \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003eC), the proportion of good versus poor outcomes varied less between SBP subgroups, with a flatter trend in the SBP 100–140 mmHg range. Although adverse outcomes increased at SBP \u0026gt; 140 mmHg, SBP did not show a significant difference in the comparison between ≤ 120 mmHg and 120–140 mmHg.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur findings provide evidence for an association between lower SBP in the first 6 h after EVT and functional independence at 90 days in patients with large-artery occlusion. Notably, SBP\u0026thinsp;\u0026le;\u0026thinsp;140 mmHg in young patients and SBP\u0026thinsp;\u0026le;\u0026thinsp;120 mmHg in older patients increased the probability of achieving favorable outcomes.\u003c/p\u003e\u003cp\u003eElevated post-EVT SBP has been shown to be correlated with worse outcomes.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e In a post hoc analysis of the ENCHANTE trial, which evaluated intensive blood pressure reduction combined with intravenous thrombolysis for acute ischemic stroke, maintaining SBP below 140 mmHg over 24 hours was linked to more favorable functional outcomes.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e And, the subgroup analysis of ENCHANTED2/MT also suggested among patients age younger than 65 years could get benefit from less intensive treatment. \u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Moreover, the goals of SBP after EVT were \u0026lt;\u0026thinsp;140 mmHg, which is applied in clinical practice,\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e such as the Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct (DAWN) trial.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Likewise, our findings also indicated that patients could benefit from controlling lower SBP within the first 6 h after EVT. A plausible explanation is that ischemic brain tissue is vulnerable to hyper-perfusion injury, including blood\u0026ndash;brain barrier disruption, cerebral edema, and hemorrhage.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Thus, the ischemic section needs to maintain low or middle perfusion in the early reperfusion phase. Moreover, the findings aligned with the investigation of the link between low SBP and functional outcomes in successful recanalization groups in our study (sensitivity analysis). Conversely, the BP-TARGET trial showed that intensive SBP (100\u0026ndash;129 mmHg) failed to reduce the odds of worse outcomes in patients with successful recanalization compared with the standard guidelines (130\u0026ndash;185 mmHg).\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e High crossover rates (33.34% within 24 h) and tandem lesions (25%) were found in this study, which might explain the discrepancy. Moreover, in this study, the interaction between age and SBP group showed fluctuating significance across the simple, adjusted, and IPTW models (P\u0026thinsp;=\u0026thinsp;0.046\u0026ndash;0.10). Notably, the consistent direction of the interaction effect across models suggests a potentially meaningful clinical trend, which warrants further validation in future studies with larger sample sizes and improved confounding control (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFurthermore, despite intensive SBP management, the prognosis of patients post-EVT with functional independence are still uncertain. Recent studies have suggested that individualized SBP strategies are crucial in patients receiving EVT based on recanalization status\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e, collateral circulation\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e, and age\u003csup\u003e\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Moreover, the findings of our study showed that the elderly could benefit from maintaining post-SBP\u0026thinsp;\u0026lt;\u0026thinsp;120 mmHg during the initial 6 hours after EVT. Maintaining low SBP after admission was associated with decreased odds of worse prognoses in older cohorts.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Subgroup analysis of the A Registration Study for Critical Care of Acute Ischemic Stroke after Recanalization (RESCUE-RE) registry, based on collateral states, explored the correlation between SBP parameters and clinical outcomes in patients undergoing EVT for large-artery occlusion.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Under conditions of poor collateral states, the probability of worse outcomes was lower in patients with SBP\u0026thinsp;\u0026lt;\u0026thinsp;120 mmHg than in those with SBP of 120\u0026ndash;140 mmHg (OR, 1.81; 95% CI, 0.97\u0026ndash;3.35) and \u0026gt;\u0026thinsp;140 mmHg (OR, 4.2; 95% CI, 1.66\u0026ndash;10.97). Older patients were observed to have weaker collaterals (ASITN/SIR grade 3\u0026ndash;4, 21.52% versus 30.34%, p\u0026thinsp;=\u0026thinsp;0.002) than younger patients, which was in line with previous reports.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e Poor collaterals were commonly associated with large cerebral infarcts,\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e severe neurological deficits,\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e\u003c/sup\u003e and worse functional outcome\u003csup\u003e\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e. Notably, high reperfusion may exacerbate cerebral edema and increase the volume of cerebral infarction in patients with severe ischemic stroke. Additionally, hypertension (47.4% vs. 69.8%, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) was more frequent in the elderly with SBP\u0026thinsp;\u0026gt;\u0026thinsp;120 mmHg. Chronic hypertension was considered to impair the autoregulation of cerebral flow.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e The autoregulation system failed to alleviate cerebral edema in the vulnerable penumbral region in patients with hyper-reperfusion,\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e\u003c/sup\u003e which could increase the risk of poor outcomes. In contrast, the ENCHANTED2/MT trial suggested that SBP less than 120 mmHg caused poor clinical prognosis than the SBP 140\u0026ndash;180 mmHg group.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e The difference could be due to long duration of insufficient reperfusion (72 h). Prolonged hypotension could get more chance to attenuate ischemia-reperfusion injury but exacerbate hypoperfusion, which is paradoxical for patients with ischemic stroke. A randomized controlled clinical trial is needed to identify the time range of maintaining low SBP in patients receiving EVT due to large artery occlusion. Besides, 110 patients who were identified with posterior circulation ischemic stroke were also included in the ENCHANTED2/MT trial, and these patients (OR,1.38; 95% CI, 1.02\u0026ndash;1.88) can benefit from less intensive treatment. Indeed, the compensatory collaterals were poorer in the posterior than anterior circulation. The exclusive enrollment of anterior large vessel occlusion patients in our study may explain the observed discrepancy.\u003c/p\u003e\u003cp\u003eSeveral investigations have indicated an association between high SBP and intracranial hemorrhage (ICH). According to the ENCHANTED trial, intensive BP lowering (\u0026lt;\u0026thinsp;140 mmHg) reduced the risk of any ICH, with a numerical but non-significant advantage in sICH, consistent with our findings. Although sICH did not differ significantly across SBP groups in our study, patients with SBP\u0026thinsp;\u0026gt;\u0026thinsp;140 mmHg showed a higher tendency, highlighting the need for caution regarding postoperative hypertension.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e Lower odds of sICH were reported to be correlated with SBP\u0026thinsp;\u0026lt;\u0026thinsp;120 mmHg in a real-world study.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e In contrast, post hoc analyses and randomized clinical trials have shown that SBP less than 180 mmHg was safe to reduce the sICH incidence in acute ischemic stroke patients.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e Our results also did not reveal a difference in sICH between the SBP groups (\u0026lt;\u0026thinsp;120 mmHg, 120\u0026ndash;140 mmHg, \u0026gt;\u0026thinsp;140 mmHg) in the younger and older cohorts. In our study, only two patients had a mean SBP\u0026thinsp;\u0026gt;\u0026thinsp;180 mmHg.\u003c/p\u003e\u003cp\u003eSeveral constraints in this study need to be acknowledged. Initially, we performed a post hoc analysis and although we adjusted the variation and used IPTW analysis to minimize any bias, the possibility of residual and unmeasured confounding remains. Moreover, not all patients who participated in the two clinical trials were enrolled because SBP data were missing from some stroke centers, particularly with SBP during 6 to 24 hours after EVT. Second, the protocol of the RESCUE BT trial was designed to include patients with ASPECTS\u0026thinsp;\u0026ge;\u0026thinsp;6, which has the limitation of generalizability in patients with acute ischemic stroke. Third, noninvasive monitoring could expose patients to obscure detailed fluctuations in SBP. Regrettably, the final infarct volume and edema, which are known effectors of functional outcomes, were not available. Fourth, given that this study was a post hoc analysis based on two randomized controlled trials, neither of which recorded detailed information on the types or administration routes of antihypertensive medications, it is possible that some patients received different antihypertensive agents or blood pressure management strategies. Moreover, this study did not analyze blood pressure variability, which may have independent prognostic value in stroke outcomes. Therefore, we cannot completely rule out the potential influence of these unmeasured variables on the study results. In conclusion, caution should be exercised when applying the findings of this study. Considering these limitations, further validation through randomized controlled trials is required to confirm our findings, ideally with study designs that incorporate individualized blood pressure management strategies tailored to stroke etiology.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings highlight that targeting systolic blood pressure at or below 140 mmHg could enhance clinical results and reduce fatality rates in younger individuals. Conversely, maintaining SBP at 120 mmHg or lower was linked to improved functional independence in older patients during the initial six hours following endovascular therapy.\u003c/p\u003e"},{"header":"Nonstandard Abbreviations and Acronyms","content":"\u003cp\u003eEndovascular therapy (EVT); systolic blood pressure (SBP); inverse probability of treatment weighting (IPTW); symptomatic intracranial hemorrhage (sICH).\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful for the dedication of all the coinvestigators of DEVT and RESCUE BT to the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding/Support:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study is funded by the Clinical Medical Research Talent Training Program (2018XLC1005), and National Outstanding Youth Foundation (81525008).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Disclosures:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo potential conflict of interest relevant to this article was reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate, Patients\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003econsent form, Ethical Approval and/or Institutional Review Board (IRB) Approval\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe trial was approved by the China Ethics Committee of Registering Clinical Trials. The approval details are as follows: DEVT (Approval No. ChiECRCT-20170101, approved on December 27, 2017) and RESCUE BT (Approval No. ChiECRCT-20180012, approved on February 8, 2018). And, informed consent from each patient and/or their legal surrogates was obtained in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData from the trial can be obtained from the corresponding author upon justified request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGoyal M, Menon BK, van Zwam WH, Dippel DWJ, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723-1731\u003c/li\u003e\n\u003cli\u003eAnadani M, Orabi MY, Alawieh A, Goyal N, Alexandrov AV, Petersen N, et al. 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Cerebrovasc Dis. 2016;41:27-34\u003c/li\u003e\n\u003cli\u003eLeng X, Fang H, Leung TWH, Mao C, Miao Z, Liu L, et al. Impact of collaterals on the efficacy and safety of endovascular treatment in acute ischaemic stroke: A systematic review and meta-analysis. J Neurol Neurosurg Psychiatry. 2016;87:537-544\u003c/li\u003e\n\u003cli\u003eCole DJ, Matsumura JS, Drummond JC, Schell RM. Focal cerebral ischemia in rats: Effects of induced hypertension, during reperfusion, on cbf. J Cereb Blood Flow Metab. 1992;12:64-69\u003c/li\u003e\n\u003cli\u003eKang B-T, Leoni RF, Kim D-E, Silva AC. Phenylephrine-induced hypertension during transient middle cerebral artery occlusion alleviates ischemic brain injury in spontaneously hypertensive rats. Brain Res. 2012;1477:83-91\u003c/li\u003e\n\u003cli\u003ePowers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the american heart association/american stroke association. Stroke. 2019;50:e344-e418\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"systolic blood pressure, age, endovascular therapy, clinical prognoses","lastPublishedDoi":"10.21203/rs.3.rs-7033548/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7033548/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOptimal systolic blood pressure (SBP) targets after endovascular therapy (EVT) for stroke in older adults (≥ 65 years) remain undefined. This study assessed age-stratified associations between early post-EVT SBP (first 6 hours) and outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost hoc analysis of two trials. Patients were stratified by age (18–64 vs. ≥65 years) and SBP (≤ 120, 120–140, \u0026gt; 140 mmHg). Primary outcome was 90-day functional status (modified Rankin Scale, mRS). Inverse probability treatment weighting (IPTW) and multivariable regression adjusted for confounders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePost-EVT SBP data were available for 267 young and 395 old patients. IPTW analysis revealed that sustained SBP below 120 mmHg during the first 6 hours post-EVT significantly enhanced functional independence in elderly patients (common OR: 2.00; 95% CI: 1.18–3.39). Among young cohorts, maintenance of SBP ≤ 120 mmHg (cOR, 2.89; 95% CI, 1.45–5.82) and 120–140 mmHg (cOR, 3.18; 95% CI, 1.58–6.47) were associated with a better outcome. sICH incidence demonstrated no statistically significant association with systolic blood pressure (SBP) levels (\u003cem\u003eP\u003c/em\u003e = 0.21; 95% CI: 0.93–1.35).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring the initial 6-hour window post- EVT, younger patients achieving SBP levels ≤ 140 mmHg and elderly patients maintaining SBP ≤ 120 mmHg demonstrated significantly improved clinical outcomes. These results suggest that stricter blood pressure control may be particularly beneficial for older adults in the early post-EVT phase.\u003c/p\u003e\n\u003cp\u003eThe DEVT registration: URL: http://www.chictr.org.cn; Chinese Clinical Trial Registry: ChiCTR-IOR-17013568, and the RESCUE BT registration: URL: http://www.chictr.org.cn; ChiCTR-INR-17014167.\u003c/p\u003e","manuscriptTitle":"Blood Pressure in the First 6 Hours for Older Adults with Stroke after Endovascular therapy: A Pooled Analysis of the DEVT and RESCUE BT Randomized Clinical Trials","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-22 08:04:28","doi":"10.21203/rs.3.rs-7033548/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1e8ae57c-b90c-411b-afa4-6ca20124f8c3","owner":[],"postedDate":"July 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-08T16:01:06+00:00","versionOfRecord":{"articleIdentity":"rs-7033548","link":"https://doi.org/10.1007/s11239-025-03178-z","journal":{"identity":"journal-of-thrombosis-and-thrombolysis","isVorOnly":false,"title":"Journal of Thrombosis and Thrombolysis"},"publishedOn":"2025-09-04 15:57:47","publishedOnDateReadable":"September 4th, 2025"},"versionCreatedAt":"2025-07-22 08:04:28","video":"","vorDoi":"10.1007/s11239-025-03178-z","vorDoiUrl":"https://doi.org/10.1007/s11239-025-03178-z","workflowStages":[]},"version":"v1","identity":"rs-7033548","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7033548","identity":"rs-7033548","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}