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

Pretreatment collateral circulation status modifies the effect of blood pressure trajectory on outcome after endovascular therapy | 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 Pretreatment collateral circulation status modifies the effect of blood pressure trajectory on outcome after endovascular therapy Zhenzhen Li, Lifan Ji, Luyao Zhang, Shiyao Zhang, Hongqiong Peng, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7331436/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background and purpose: Blood pressure (BP) management in the acute phage of stroke is associated with clinical outcomes among patients with after endovascular therapy (EVT). This study was to explore whether collateral circulation status modified the effect of BP course on clinical outcomes in patients with EVT. Methods: This study enrolled a total of 800 patients with ischemic stroke caused by large-vessel occlusion in the anterior circulation who underwent successful recanalization. Latent mixture modeling was used to determine systolic BP (SBP) trajectories according to 3 SBP measurements during the first 24 hours after EVT. Collateral status prior to EVT was assessed by digital subtracted angiography. Clinical outcomes including stroke disability (modified Rankin Scale 3-6), mortality, and symptomatic intracranial hemorrhage (sICH) were collected 90 days after stroke. Results: Three SBP trajectories were identified: high (7%), moderate 57.9%, and low (35.1%) SBP. SBP trajectories were independently associated with unfavorable 90-d outcome ( P =0.012) after adjustment. Patients with high and moderate SBP trajectories had had an elevated risk of unfavorable outcome in the poor collateral (adjusted odds ratio, 6.19 [95%CI, 2.17-17.67], P <0.001 and adjusted odds ratio, 2.10 [95%CI, 1.23-3.57], P =0.007, respectively) rather than good collateral ( P for interaction: 0.042). There was no significant difference regarding mortality and sICH across SBP trajectories. Conclusions: Patients with high or moderate SBP trajectory during the first 24 hours after successful recanalization had a higher risk of unfavorable outcome among patients with poor collateral. Registration: https://www.clinicaltrials.gov/ct2/show/NCT04775147; https://www.clinicaltrials.gov/ct2/show/NCT04230785 Unique identifier: NCT04775147 (registered on March 01, 2021) and NCT04230785 (registered on January18, 2020). blood pressure endovascular therapy trajectory outcome collateral status Figures Figure 1 Figure 2 Figure 3 Introduction Mounting evidence has confirmed the efficacy of endovascular therapy (EVT) in ischemic stroke patients caused by anterior circulation large vessel occlusion [ 1 ]. Nevertheless, nearly half of individuals with successful recanalization still achieve unfavorable outcome which are usually considered as futile recanalization [ 2 , 3 ]. Therefore, besides improving the recanalization rates [ 4 ], investigating other impacting indicators for futile recanalization is critical in the administration of ischemic stroke patients undergoing EVT. Blood pressure (BP) in the acute phage of ischemic stroke has been widely evaluated regarding clinical outcomes [ 5 ]. Previous studies have suggested that elevated BP after EVT was associated with symptomatic intracranial hemorrhage (sICH) and unfavorable outcome [ 6 – 8 ]. Several multicenter studies showed that patients with lower systolic BP were associated with worse outcome after EVT with successful recanalization [ 9 ]. However, higher SBP variability in the first 24 hours after successful EVT was associated with a higher risk of worse outcome in patients with poor collateral [ 10 ]. In comparison, the issue regarding BP management remains elusive, especially dynamic changes of BP over time. Existing evidence has showed that SBP trajectories during the first 24 hours after intravenous alteplase or 12 months after discharge were associated with clinical outcomes in patients with ischemic stroke [ 11 , 12 ]. However, few investigations have focused on the clinical significance of BP trajectory in ischemic stroke patients receiving EVT. The purpose of this study was to characterize SBP trajectory profiles after EVT and to explore whether collateral circulation status modified the effect of BP trajectory on clinical outcomes in patients with EVT. Methods Study protocol and data availability The data that confirm the results of this study are available from the corresponding author upon reasonable request. This study was performed based on clinical information from two registry studies (NCT04230785(registered on January18, 2020) and NCT04230785(registered on January18, 2020)). Detailed information on the description of baseline characteristics and methods has been reported previously [ 13 ]. In accordance with the Declaration of Helsinki, written informed consent was obtained from all participants and this study protocol was approved by the medical ethics committee of Nanjing First Hospital, Nanjing Medical University and the Affiliated ZhongDa Hospital of Southeast University. Study population From Marth 2020 to October 2024, ischemic stroke patients caused by large-vessel occlusion in the anterior circulation were included in this study if they had been treated in Nanjing First Hospital, Nanjing Medical University, the Affiliated ZhongDa Hospital of Southeast University and six sub-centers that were available to obtain BP data of the first 24 hours after EVT. Participants were enrolled if they followed the inclusion criteria: (1) age > 18 years old; (2) successful recanalization defined as modified Thrombolysis in Cerebral Infarction (mTICI) score [ 14 ] of 2b or 3 after EVT; (3) preoperative collateral status determined by digital subtraction angiography; and (4) available follow-up data for 90 days. Patients with unavailable BP value for 24 hours after EVT, incomplete images on digital subtraction angiography, and absence of follow-up were excluded. Blood pressure measurement and data collection BP measurement was performed every 15 minutes for 2 hours, every 30 minutes at 2 to 6 hours, and every 1 hour at 7 to 24 hours after EVT. The baseline characteristics of the study participants were systematically collected, encompassing demographics, clinical characteristics, medical histories, and procedural characteristics. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) at baseline [ 15 ]. Collateral status was assessed according to digital subtracted angiography images as previously reported [ 16 ], and we defined grade 2 to 4 as good and grade 0 to 1 as poor collateral status in the present study [ 10 ]. BP trajectory modeling SBP trajectories during the first 24 hours after EVT were generated by using latent variable mixture modeling within the PROC TRAJ procedure in SAS software, which discriminated longitudinal data into groups with similar profiles by a maximum likelihood method [ 17 ]. The optimal shape and number of trajectories were identified by the Bayesian Information Criteria. Timescales were determined in three times during the first 24 hours after EVT (2 hours, 12 hours, and 24 hours after EVT) (Fig. 1 ). Trajectory models were assessed according to all available SBP data after EVT, suggesting that had 3 distinct SBP trajectory groups by using the Bayesian Information Criterion value. Additionally, models with 4 or 5 SBP trajectory groups were further evaluated, but their fit and complexity were not improved compared with those using 3 groups. These 3 trajectories were named as high, moderate, and low groups based on the appearances of dynamic change of SBP (Fig. 2 ). Outcomes The primary outcome was stroke-associated disability which was estimated by the modified Rankin Scale (mRS) at 90 days (Fig. 1 ) [ 18 ]. A mRS score of 3 to 6 was defined as poor outcome which was also called futile recanalization. Secondary outcomes included sICH and mortality at 90 days. sICH was defined as any hemorrhage on post-EVT CT with ≥ 4 points increase in NIHSS within 7 days after EVT according to European-Australasian Acute Stroke Study (ECASS) П criteria [ 19 ]. Statistical analysis For baseline characteristics, categorical variables were expressed as numbers and percentages, continuous variables with normal distribution as means and standard deviation (SD), and continuous variables with skewed distribution as medians and interquartile ranges. Baseline characteristics were compared among patients with different SBP trajectories or functional outcomes. The univariate analyses of categorical variables were analyzed by Χ 2 test, and continuous variables by student t , ANOVA or Mann-Whitney U tests as appropriate. Multivariable logistic regression analyses were used to assess the independent correlations of SBP trajectories with functional outcomes by adjusting for potential confounders including age, sex, medical history, clinical data, occlusion site, the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data. Furthermore, we performed a subgroup analysis based on the collateral status. An interaction model was used to test for interaction effects of SBP trajectories with the collateral status. All statistical analyses were conducted with SAS 9.4 (SAS Institute Inc, Cary, NC). Results Study population and SBP trajectories A total of 983 patients caused by large-vessel occlusion in the anterior circulation were consecutively enrolled in our cohort. After excluding 78 patients without successful recanalization, 57 without available BP data during the first 24 hours after EVT, 43 without DSA data, and 5 without 90-d follow-up, 800 patients were included in the final analysis (Fig. 3 ). For the enrolled patients, the median age was 67 (interquartile range [IQR] 57–75) years and 61.3% of the enrolled patients was male. The median score of NIHSS was 15 (IQR 11–18) and 45.8% of the patients had good collateral status. Middle cerebral artery occlusion was observed in 61.1% of the participants. As for stroke etiology, 51.8% were from large artery atherosclerosis and 42.1% were cardioembolic. Three SBP trajectories after EVT were identified (Fig. 2 ). Two hundred and eighty-one patients (35.1%) were included in the low SBP trajectory. Moderate SBP trajectory had the largest percent of the patients at 57.9%. Patients with consecutively high SBP included the small percentage of subjects at 7%. Baseline characteristics, such as sex, medical history (hypertension, diabetes mellitus, previous stroke and smoking), baseline NIHSS, occlusion site, time from onset to recanalization, collateral status, stroke etiology, antihypertensive therapy, and baseline blood glucose level, were markedly different among the 3 SBP trajectory subgroups ( P < 0.05, Table 1 ). However, difference was not found in the distribution of age, baseline Alberta Stroke Program Early CT Score (ASPECTS), and intravenous thrombolysis across trajectory groups. Table 1 Baseline characteristics of the enrolled participants according to SBP trajectories Characteristics Low (n = 281) Moderate (n = 463) High (n = 56) P value Age, y, median (IQR) 66 (56–75) 68 (58–75) 65 (57–72) 0.227 Sex (male), n (%) 149 (53.0) 298 (64.4) 43 (76.8) < 0.001 Medical history, n (%) Hypertension 116 (41.3) 277 (59.8) 48 (85.7) < 0.001 Diabetes mellitus 43 (15.3) 102 (22.0) 23 (41.0) < 0.001 Previous stroke 40 (14.2) 92 (19.9) 16 (28.6) 0.021 Coronary heart disease 47 (16.7) 85 (18.4) 8 (14.3) 0.686 Atrial fibrillation 70 (24.9) 90 (19.4) 14 (25.0) 0.178 Smoking 71 (25.3) 164 (35.4) 21 (37.5) 0.010 Clinical data Baseline NIHSS, median (IQR) 15 (12–20) 14 (11–18) 14 (11–16) 0.008 Baseline ASPECTS, median (IQR) 8 (6–9) 8 (7–9) 8 (8–9) 0.062 Occlusion site, n (%) 0.005 Internal carotid occlusion 124 (44.1) 175 (37.8) 12 (21.4) Middle cerebral artery occlusion 157 (55.9) 288 (62.2) 44 (78.6) Procedure treatment Time from onset to recanalization, min, median (IQR) 469 (330–630) 429 (320–570) 498 (390–635) 0.027 Antihypertensive 113 (40.2) 289 (62.4) 41 (73.2) < 0.001 Intravenous thrombolysis 95 (33.8) 170 (36.7) 18 (32.1) 0.631 ASITN/SIR collateral grading, n (%) 0.040 Poor collateral (0–1) 113 (40.2) 222 (47.9) 31 (55.4) Good collateral (2–4) 168 (59.8) 241 (52.1) 25 (44.6) Stroke etiology, n (%) < 0.001 Large artery atherosclerosis 117 (41.6) 255 (55.1) 42 (75.0) Cardioembolic 146 (52.0) 178 (38.4) 13 (23.2) Others 18 (6.4) 30 (6.5) 1 (1.8) Laboratory data Baseline blood glucose level, mmol/L, mean ± SD 7.0 ± 2.7 7.6 ± 3.3 7.6 ± 5.9 < 0.001 hs-CRP, mg/L, median (IQR) 8.3 (2.6–23.8) 10.2 (4.2–29.3) 9.3 (2.0-17.1) 0.341 Serum creatinine, µmoI/L, median (IQR) 65.7 (55.1–80.3) 67.5 (55.9–84.0) 65.8 (54.3–82.5) 0.636 Total cholesterol, mmol/L, mean ± SD 4.0 ± 1.1 4.1 ± 1.0 4.3 ± 1.0 0.336 Triglyceride, mmol/L, mean ± SD 1.3 ± 1.2 1.3 ± 0.8 1.2 ± 0.8 0.905 Low-density lipoprotein, mmol/L, median (IQR) 2.4 (1.9–3.1) 2.3 (1.8-3.0) 2.7 (2.2–3.1) 0.190 High-density lipoprotein, mmol/L, median (IQR) 1.2 (0.4–1.4) 1.1 (0.9–1.3) 1.1 (0.9–1.4) 0.817 SBP, systolic blood pressure; NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early CT Score; IQR, interquartile range; ASITN/SIR, American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology; hs-CRP, high sensitivity C-reactive protein; mRS, modified Rankin Scale. Association of SBP trajectories and outcomes A total of 402 (50.2%) subjects experienced unfavorable outcome (mRS, 3–6) at 90 days, 26 (3.3%) subjects developed sICH, and 99 (12.4%) subjects experienced death after EVT (Table 2 ). Compared with the subjects with low SBP trajectory, those in the high trajectory had higher incidence of unfavorable outcome ( P = 0.024) but not sICH ( P = 0.704) and mortality ( P = 0.690) at 90 days. Multivariable-adjusted odds ratio (95% confidence interval [CI]) for 90-d mRS (3–6) was 2.81 (1.42–5.57) among subjects in high and low SBP trajectory groups after adjusting for age, sex, medical history, clinical data, occlusion site, ASITN/SIR collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data. However, there was no significant difference between SBP trajectories and the secondary outcomes in multivariable analyses. Table 2 Clinical outcomes and systolic blood pressure trajectories within 24 hours after endovascular therapy Clinical outcomes Low (n = 281) Moderate (n = 463) High (n = 56) P value OR (95%CI) OR (95%CI) 90-d mRS score 3–6 Events (%) 130 (46.26) 235 (50.76) 37 (66.07) P value 0.024 Age- and sex-adjusted 1.00 (Ref) 1.15 (0.85–1.56) 2.33 (1.26–4.30) 0.026 Multivariable-adjusted* 1.00 (Ref) 1.27 (0.91–1.78) 2.81 (1.42–5.57) 0.012 Symptomatic intracerebral hemorrhage Events (%) 11 (3.91) 13 (2.81) 2 (3.57) P value 0.704 Age- and sex-adjusted 1.00 (Ref) 0.67 (0.30–1.53) 0.91 (0.19–4.26) 0.632 Multivariable-adjusted* 1.00 (Ref) 0.59 (0.24–1.43) 0.79 (0.15–4.19) 0.504 Mortality within 90 days Events (%) 31 (11.03) 61 (13.17) 7 (12.50) P value 0.690 Age- and sex-adjusted 1.00 (Ref) 1.14 (0.74–1.76) 1.14 (0.50–2.60) 0.837 Multivariable-adjusted* 1.00 (Ref) 1.16 (0.73–1.84) 1.20 (0.50–2.87) 0.857 OR, odds ratio; CI, confidence interval; mRS, modified Rankin Scale. *Multivariable-adjusted for age, sex, medical history, clinical data, occlusion site, ASITN/SIR collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data (baseline blood glucose level, hs-CRP, total cholesterol, and low-density lipoprotein). In the subgroup analysis stratified by collateral status, subjects with poor collateral had higher proportions of unfavorable outcome in the high SBP trajectory ( P = 0.002) but not those with good collateral ( P = 0.628) (Table 3 ). Compared with subjects with low SBP trajectory, those with moderate (OR 2.10, 95%CI, 1.23–3.57) or high SBP trajectories (OR 6.19, 95%CI, 2.17–17.67) still had higher risk of unfavorable outcome in the poor collateral group ( P = 0.001) after adjustment, and the interaction effect was significant ( P = 0.042). As for secondary outcomes, this trend was not observed in different collateral status. Table 3 Clinical outcomes of systolic blood pressure trajectories within 24 hours according to collateral status Clinical outcomes Poor collateral (n = 366) Good collateral (n = 434) P value for interaction Low (n = 113) Moderate (n = 222) High (n = 31) P value Low (n = 168) Moderate (n = 241) High (n = 25) P value OR (95%CI) OR (95%CI) OR (95%CI) OR (95%CI) 90-d mRS score 3–6 Events (%) 50 (44.25) 129 (58.11) 24 (77.42) 80 (47.62) 106 (43.98) 13 (52.00) P value 0.002 0.628 Age- and sex-adjusted 1.00 (Ref) 1.78 (1.11–2.85) 4.83 (1.89–12.36) 0.002 1.00 (Ref) 0.80 (0.53–1.21) 1.13 (0.48–2.70) 0.477 0.025 Multivariable-adjusted* 1.00 (Ref) 2.10 (1.23–3.57) 6.19 (2.17–17.67) 0.001 1.00 (Ref) 0.93 (0.59–1.45) 1.56 (0.60–4.01) 0.522 0.042 Symptomatic intracerebral hemorrhage Events (%) 4 (3.54) 9 (4.05) 2 (6.45) 7 (1.61) 4 (1.66) 0 (0) P value 0.791 0.161 Age- and sex-adjusted 1.00 (Ref) 1.14 (0.34–3.84) 1.94 (0.33–11.37) 0.755 1.00 (Ref) 0.36 (0.10–1.26) - 0.276 0.491 Multivariable-adjusted* 1.00 (Ref) 1.47 (0.40–5.39) 4.02 (0.49–32.69) 0.428 1.00 (Ref) 0.25 (0.06–0.98) - 0.137 0.504 Mortality within 90 days Events (%) 14 (12.39) 30 (13.51) 6 (19.35) 17 (10.12) 31 (12.86) 1 (4.00) P value 0.603 0.283 Age- and sex-adjusted 1.00 (Ref) 1.02 (0.54–1.93) 1.64 (0.63–4.31) 0.539 1.00 (Ref) 1.23 (0.68–2.22) 0.37 (0.05–2.79) 0.426 0.305 Multivariable-adjusted* 1.00 (Ref) 1.00 (0.51–1.97) 1.65 (0.57–4.79) 0.573 1.00 (Ref) 1.50 (0.78–2.88) 0.41 (0.05–3.17) 0.237 0.230 OR, odds ratio; CI, confidence interval; mRS, modified Rankin Scale. *Multivariable-adjusted for age, sex, medical history, clinical data, occlusion site, ASITN/SIR collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data (baseline blood glucose level, hs-CRP, total cholesterol, and low-density lipoprotein). Discussion This study showed heterogeneous SBP trajectory profiles in a prospective cohort of 800 patients with ischemic stroke caused by large-vessel occlusion in the anterior circulation, and 3 distinct SBP trajectories were identified during the first 24 hours after successful recanalization. These trajectory groups were obviously different in relation to risk for functional outcome. The patients with high trajectory were more likely to be correlated with unfavorable outcome. Importantly, subgroup analyses demonstrated that the patients with high and moderate trajectories within 24 hours had the higher risk of worse outcome compared with those with low trajectory in the poor collateral. These findings indicate that maintaining SBP of 112 ± 7.6 mmHg within the first 24 hours after successful recanalization may be beneficial to improve the functional outcome in ischemic stroke patients with poor collateral. Most of patients caused by large-vessel occlusion have elevated BP levels above 140 mmHg in the acute phage of ischemic stroke [ 20 , 21 ]. This phenomenon is often considered as a compensatory physiological function to supplement cerebral perfusion for maintaining blood flow in the ischemic lesion [ 22 ]. BP change, an acute stress response to the neurological deficit, may be affected by decreased baroreceptor sensitivity and damaged central autonomic pathways [ 23 , 24 ]. A recently published study suggested that patients with high maximum SBP in acute stressful conditions had higher risk of unfavorable outcome compared with those with low maximum SBP [ 25 ]. However, the ENCHANTED2/MT study has demonstrated that intensive control of SBP to lower than 120 mm Hg was harmful in patients who received EVT [ 26 ]. Another study suggested that higher SBP during the first 24 hours was correlated with worse outcome in patients with ischemic stroke after successful recanalization [ 10 ]. In the view of this contradiction, trajectory profiles of SBP fluctuation in ischemic stroke patients may represent the personal response of autonomic nervous system to an ischemic injury [ 27 ]. Patients with high trajectory during the first 24 hours of hospitalization were associated with worse outcome, which might be due to an abnormal response of baroreceptor sensitivity [ 28 ]. Our data showed that SBP change over the first 24 hours followed 3 unique trajectories that improved our knowledge of the association between SBP after EVT and clinical outcomes. SBP trajectory groups exhibited the varied risk of neurological dysfunction. Patients with high BP (high trajectory) after EVT had an elevated risk of worse outcome compared with those with low trajectory, and a mean SBP of 111 mmHg was associated with favorable outcome after EVT, in line with a previous study [ 29 ]. However, the previous study showed 5 distinct trajectories during the first 72 hours after EVT which were associated with functional outcome [ 29 ]. These inconsistent trajectories may result from recanalization status and BP time of duration. Generally, higher BP is not required after successful reperfusion which may aggravate brain injury. More importantly, the subsequent damage of cerebral autoregulation impairs the cerebrovascular capacity in the regulation of abnormal BP, and the hyperperfusion caused by high BP further facilitates secondary cerebral damage from cerebral hemorrhage and edema [ 30 , 31 ]. Nevertheless, trajectory groups were not associated with sICH and mortality in the present study. We found the significant relationship between BP trajectories and stroke disability. These findings were consistent with previous reports [ 29 , 32 ]. This contradiction indicates that the facilitation of poor outcome by increased SBP may not be mainly mediated by sICH. A report showed that higher mean SBP increased the risk of hemicraniectomy in ischemic stroke patients after EVT [ 33 ], and elevated BP was considered to be correlated with cerebral edema [ 34 ]. Therefore, the influence of high BP on stroke outcomes may be partially mediated by cerebral edema after EVT. Concern on the relationship between post-procedure BP and clinical outcomes in ischemic stroke patients after successful recanalization stratified by collateral status remained infrequent. A recent study suggested that the time of periprocedural mean arterial pressure less than 90 mmHg was positively associated with worse outcome in patients with poor collateral but not in those with good collateral [ 35 ]. Patients with elevated post-procedural SBP had the increased risk of unfavorable outcome in the poor collateral rather than good collateral [ 10 ]. These findings suggest the potential clinical significance of collateral status on BP management at perioperative period. In the present study, similar findings of post-EVT BP were also observed in patients with poor collateral. Therefore, maintaining SBP of 112 ± 7.6 mmHg may be beneficial to improve the clinical outcomes in the acute phage of patients with poor collateral after successful recanalization. Existing evidence could not provide a guidance in BP management for ischemic stroke patients after EVT. Several trials and observational studies have reported a contradictory association of BP control with clinical outcome in patients with successful thrombectomy [ 26 , 32 , 36 , 37 ]. However, periprocedural BP management is complicated due to absence of uniform profiles of physiology, suggesting a more personalized management of BP. The impact of the personalized factors on post-EVT BP is elusive. Our data showed that an underlying male, history of hypertension, diabetes mellitus, previous stroke, smoking, occlusion site, stroke etiology, antihypertensive therapy, and baseline blood glucose level may be implicated. We observed a higher prevalence of hypertension history among patients with the high SBP trajectory. Furthermore, the high and moderate trajectory groups had higher rates of antihypertensive treatment after EVT. However, the antihypertensive medication did not modify the effect of the BP trajectory on functional outcome. While this multicenter cohort study established precise SBP trajectories and explored the effect of post-procedure BP on outcomes in ischemic stroke patients with successful recanalization based on collateral status, several limitations should be acknowledged. First, this study had no standardized BP management protocol across centers, and it is uncertain in the targets of BP control for patients. Second, while this study included antihypertensive treatment, we did not record the timing of antihypertensive medication. Third, there were higher proportions of large artery atherosclerosis in Chinese populations, further research should perform in western populations to confirm the reproducibility of our findings. In summary, this study displays a longitudinal pattern of SBP during the first 24 hours after successful thrombectomy. Patients with ischemic stroke have 3 distinct SBP trajectories that were associated with unfavorable outcome in the poor collateral but not in the good collateral. Abbreviations BP blood pressure SBP systolic BP EVT endovascular therapy sICH symptomatic intracranial hemorrhage mTICI modified Thrombolysis in Cerebral Infarction NIHSS National Institutes of Health Stroke Scale ECASS European-Australasian Acute Stroke Study ASITN/SIR American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology DSA digital subtraction angiograph IQR interquartile range ASPECTS Alberta Stroke Program Early CT Score OR odds ratio CI confidence interval. Declarations Ethics approval and consent to participate Research involving Human Participants The studies involving human participants were reviewed and approved by the Ethics Committee of Nanjing First Hospital, Nanjing Medical University. Informed consent The patients/participants provided their written informed consent to participate in this study. Declaration of Helsinki The study protocol has been carried out in accordance with the Declaration of Helsinki of the World Medical Association. Availability of data and material The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding authors. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Consent for publication Not Applicable. Funding This work was supported by the National Science and Technology Innovation 2030–Major Program of Brain Science and Brain-Inspired Intelligence Research (2021ZD0201807); Nanjing Medical Science and Technology Development Foundation (YKK23111); Medjaden Academy & Research Foundation for Young Scientists (No. MJR202310040 and No. MJR202410130); Nanjing Medical University Science and Technique Development Foundation Project (NMUB20220060); Nanjing Medical Science and Technique Development Foundation Project (ZKX22031); Postgraduate Research & Practice Innovation Program of Jiangsu Province (SJCX24_0763); Key Project of Jiangsu Provincial Youth Talent Program(NO. JSSA2024ZD02). Authors' contributions Data curation, ZZL, LFJ, LYZ and SYZ; Formal analysis, ZHH, HQP and YTZ; Investigation, HLS, LZ, YFQ and MMG; Project administration, SL, YDY and QWD; Writing – original draft, QWD; Writing – review & editing, SL, YDY and QWD. 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Lancet Neurol. 2021;20(4):265–74. 10.1016/S1474-4422(20)30483-X . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7331436","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":513966246,"identity":"1dca9ebb-f874-40fe-9249-72c256ff7df5","order_by":0,"name":"Zhenzhen Li","email":"","orcid":"","institution":"Nanjing Medical University","correspondingAuthor":false,"prefix":"","firstName":"Zhenzhen","middleName":"","lastName":"Li","suffix":""},{"id":513966247,"identity":"9bed2e31-09c7-46bc-88bd-7305d8ebfc78","order_by":1,"name":"Lifan Ji","email":"","orcid":"","institution":"China Pharmaceutical 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1","display":"","copyAsset":false,"role":"figure","size":55364,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTimeline of blood pressure measurements after EVT and follow-up evaluation. \u003c/strong\u003eBP, blood pressure; SBP, systolic blood pressure; EVT, endovascular therapy.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-7331436/v1/c2275aca70ee5b5596164758.png"},{"id":91843725,"identity":"cb760997-473e-49de-a305-0cc8d7c60275","added_by":"auto","created_at":"2025-09-22 10:07:25","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":789626,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSBP trajectories during the first 24 hours after EVT.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree SBP trajectories were determined over the first 24 hours after EVT by using the Bayesian Information Criterion value. SBP, systolic blood pressure; EVT, endovascular therapy.\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-7331436/v1/dba7f88adc7c0386893bfa7f.png"},{"id":91842301,"identity":"62e5fdb6-6faa-4d6a-8652-9530b48f9e93","added_by":"auto","created_at":"2025-09-22 09:59:25","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":646625,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFlowchart of the study.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003emTICI, modified Thrombolysis in Cerebral Ischemia; DSA, digital subtraction angiograph.\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-7331436/v1/e0d1f2fe7366aba2a8b08944.png"},{"id":108082515,"identity":"bb7ebadd-b8eb-4119-bdbe-9cc6a7c171c6","added_by":"auto","created_at":"2026-04-29 07:57:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2029086,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7331436/v1/ed50f861-8e23-40b1-b8c4-d5248b37352a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Pretreatment collateral circulation status modifies the effect of blood pressure trajectory on outcome after endovascular therapy","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMounting evidence has confirmed the efficacy of endovascular therapy (EVT) in ischemic stroke patients caused by anterior circulation large vessel occlusion [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Nevertheless, nearly half of individuals with successful recanalization still achieve unfavorable outcome which are usually considered as futile recanalization [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, besides improving the recanalization rates [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], investigating other impacting indicators for futile recanalization is critical in the administration of ischemic stroke patients undergoing EVT.\u003c/p\u003e\u003cp\u003eBlood pressure (BP) in the acute phage of ischemic stroke has been widely evaluated regarding clinical outcomes [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Previous studies have suggested that elevated BP after EVT was associated with symptomatic intracranial hemorrhage (sICH) and unfavorable outcome [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Several multicenter studies showed that patients with lower systolic BP were associated with worse outcome after EVT with successful recanalization [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, higher SBP variability in the first 24 hours after successful EVT was associated with a higher risk of worse outcome in patients with poor collateral [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In comparison, the issue regarding BP management remains elusive, especially dynamic changes of BP over time. Existing evidence has showed that SBP trajectories during the first 24 hours after intravenous alteplase or 12 months after discharge were associated with clinical outcomes in patients with ischemic stroke [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, few investigations have focused on the clinical significance of BP trajectory in ischemic stroke patients receiving EVT.\u003c/p\u003e\u003cp\u003eThe purpose of this study was to characterize SBP trajectory profiles after EVT and to explore whether collateral circulation status modified the effect of BP trajectory on clinical outcomes in patients with EVT.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy protocol and data availability\u003c/h2\u003e\u003cp\u003eThe data that confirm the results of this study are available from the corresponding author upon reasonable request. This study was performed based on clinical information from two registry studies (NCT04230785(registered on January18, 2020) and NCT04230785(registered on January18, 2020)). Detailed information on the description of baseline characteristics and methods has been reported previously [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In accordance with the Declaration of Helsinki, written informed consent was obtained from all participants and this study protocol was approved by the medical ethics committee of Nanjing First Hospital, Nanjing Medical University and the Affiliated ZhongDa Hospital of Southeast University.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eFrom Marth 2020 to October 2024, ischemic stroke patients caused by large-vessel occlusion in the anterior circulation were included in this study if they had been treated in Nanjing First Hospital, Nanjing Medical University, the Affiliated ZhongDa Hospital of Southeast University and six sub-centers that were available to obtain BP data of the first 24 hours after EVT. Participants were enrolled if they followed the inclusion criteria: (1) age\u0026thinsp;\u0026gt;\u0026thinsp;18 years old; (2) successful recanalization defined as modified Thrombolysis in Cerebral Infarction (mTICI) score [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] of 2b or 3 after EVT; (3) preoperative collateral status determined by digital subtraction angiography; and (4) available follow-up data for 90 days. Patients with unavailable BP value for 24 hours after EVT, incomplete images on digital subtraction angiography, and absence of follow-up were excluded.\u003c/p\u003e\n\u003ch3\u003eBlood pressure measurement and data collection\u003c/h3\u003e\n\u003cp\u003eBP measurement was performed every 15 minutes for 2 hours, every 30 minutes at 2 to 6 hours, and every 1 hour at 7 to 24 hours after EVT. The baseline characteristics of the study participants were systematically collected, encompassing demographics, clinical characteristics, medical histories, and procedural characteristics. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) at baseline [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Collateral status was assessed according to digital subtracted angiography images as previously reported [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], and we defined grade 2 to 4 as good and grade 0 to 1 as poor collateral status in the present study [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eBP trajectory modeling\u003c/h3\u003e\n\u003cp\u003eSBP trajectories during the first 24 hours after EVT were generated by using latent variable mixture modeling within the PROC TRAJ procedure in SAS software, which discriminated longitudinal data into groups with similar profiles by a maximum likelihood method [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The optimal shape and number of trajectories were identified by the Bayesian Information Criteria. Timescales were determined in three times during the first 24 hours after EVT (2 hours, 12 hours, and 24 hours after EVT) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Trajectory models were assessed according to all available SBP data after EVT, suggesting that had 3 distinct SBP trajectory groups by using the Bayesian Information Criterion value. Additionally, models with 4 or 5 SBP trajectory groups were further evaluated, but their fit and complexity were not improved compared with those using 3 groups. These 3 trajectories were named as high, moderate, and low groups based on the appearances of dynamic change of SBP (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eOutcomes\u003c/h3\u003e\n\u003cp\u003eThe primary outcome was stroke-associated disability which was estimated by the modified Rankin Scale (mRS) at 90 days (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. A mRS score of 3 to 6 was defined as poor outcome which was also called futile recanalization. Secondary outcomes included sICH and mortality at 90 days. sICH was defined as any hemorrhage on post-EVT CT with \u0026ge;\u0026thinsp;4 points increase in NIHSS within 7 days after EVT according to European-Australasian Acute Stroke Study (ECASS) П criteria [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eFor baseline characteristics, categorical variables were expressed as numbers and percentages, continuous variables with normal distribution as means and standard deviation (SD), and continuous variables with skewed distribution as medians and interquartile ranges. Baseline characteristics were compared among patients with different SBP trajectories or functional outcomes. The univariate analyses of categorical variables were analyzed by \u003cem\u003eΧ\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e test, and continuous variables by student \u003cem\u003et\u003c/em\u003e, ANOVA or Mann-Whitney \u003cem\u003eU\u003c/em\u003e tests as appropriate. Multivariable logistic regression analyses were used to assess the independent correlations of SBP trajectories with functional outcomes by adjusting for potential confounders including age, sex, medical history, clinical data, occlusion site, the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data. Furthermore, we performed a subgroup analysis based on the collateral status. An interaction model was used to test for interaction effects of SBP trajectories with the collateral status. All statistical analyses were conducted with SAS 9.4 (SAS Institute Inc, Cary, NC).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003eStudy population and SBP trajectories\u003c/h2\u003e\u003cp\u003eA total of 983 patients caused by large-vessel occlusion in the anterior circulation were consecutively enrolled in our cohort. After excluding 78 patients without successful recanalization, 57 without available BP data during the first 24 hours after EVT, 43 without DSA data, and 5 without 90-d follow-up, 800 patients were included in the final analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). For the enrolled patients, the median age was 67 (interquartile range [IQR] 57\u0026ndash;75) years and 61.3% of the enrolled patients was male. The median score of NIHSS was 15 (IQR 11\u0026ndash;18) and 45.8% of the patients had good collateral status. Middle cerebral artery occlusion was observed in 61.1% of the participants. As for stroke etiology, 51.8% were from large artery atherosclerosis and 42.1% were cardioembolic.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThree SBP trajectories after EVT were identified (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Two hundred and eighty-one patients (35.1%) were included in the low SBP trajectory. Moderate SBP trajectory had the largest percent of the patients at 57.9%. Patients with consecutively high SBP included the small percentage of subjects at 7%. Baseline characteristics, such as sex, medical history (hypertension, diabetes mellitus, previous stroke and smoking), baseline NIHSS, occlusion site, time from onset to recanalization, collateral status, stroke etiology, antihypertensive therapy, and baseline blood glucose level, were markedly different among the 3 SBP trajectory subgroups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). However, difference was not found in the distribution of age, baseline Alberta Stroke Program Early CT Score (ASPECTS), and intravenous thrombolysis across trajectory groups.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\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\u003eBaseline characteristics of the enrolled participants according to SBP trajectories\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristics\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;281)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;463)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\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\u003eAge, y, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e66 (56\u0026ndash;75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e68 (58\u0026ndash;75)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65 (57\u0026ndash;72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.227\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex (male), n (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e149 (53.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e298 (64.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e43 (76.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\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\u003e116 (41.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e277 (59.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e48 (85.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiabetes mellitus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e43 (15.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e102 (22.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23 (41.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrevious stroke\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40 (14.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92 (19.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16 (28.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCoronary heart disease\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e85 (18.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (14.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.686\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\u003e70 (24.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e90 (19.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (25.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.178\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSmoking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71 (25.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e164 (35.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.010\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical data\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline NIHSS, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15 (12\u0026ndash;20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14 (11\u0026ndash;18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14 (11\u0026ndash;16)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline ASPECTS, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8 (6\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8 (7\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8 (8\u0026ndash;9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOcclusion site, 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\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.005\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternal carotid occlusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e124 (44.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e175 (37.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12 (21.4)\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\u003eMiddle cerebral artery occlusion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e157 (55.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e288 (62.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44 (78.6)\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\u003eProcedure treatment\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTime from onset to recanalization, min, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e469 (330\u0026ndash;630)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e429 (320\u0026ndash;570)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e498 (390\u0026ndash;635)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntihypertensive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113 (40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e289 (62.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41 (73.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntravenous thrombolysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e95 (33.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e170 (36.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18 (32.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.631\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eASITN/SIR collateral grading, 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\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.040\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePoor collateral (0\u0026ndash;1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113 (40.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e222 (47.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e31 (55.4)\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\u003eGood collateral (2\u0026ndash;4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e168 (59.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e241 (52.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25 (44.6)\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\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=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\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\u003e117 (41.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e255 (55.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e42 (75.0)\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\u003eCardioembolic\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e146 (52.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e178 (38.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13 (23.2)\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\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18 (6.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (6.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1 (1.8)\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\u003eLaboratory data\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBaseline blood glucose level, mmol/L, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehs-CRP, mg/L, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8.3 (2.6\u0026ndash;23.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.2 (4.2\u0026ndash;29.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e9.3 (2.0-17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.341\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSerum creatinine, \u0026micro;moI/L, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e65.7 (55.1\u0026ndash;80.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67.5 (55.9\u0026ndash;84.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e65.8 (54.3\u0026ndash;82.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.636\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal cholesterol, mmol/L, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4.0\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.336\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTriglyceride, mmol/L, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;1.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2\u0026thinsp;\u0026plusmn;\u0026thinsp;0.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.905\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow-density lipoprotein, mmol/L, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.4 (1.9\u0026ndash;3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3 (1.8-3.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.7 (2.2\u0026ndash;3.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh-density lipoprotein, mmol/L, median (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.2 (0.4\u0026ndash;1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 (0.9\u0026ndash;1.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.1 (0.9\u0026ndash;1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.817\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eSBP, systolic blood pressure; NIHSS, National Institutes of Health Stroke Scale; ASPECTS, Alberta Stroke Program Early CT Score; IQR, interquartile range; ASITN/SIR, American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology; hs-CRP, high sensitivity C-reactive protein; mRS, modified Rankin Scale.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eAssociation of SBP trajectories and outcomes\u003c/h2\u003e\u003cp\u003eA total of 402 (50.2%) subjects experienced unfavorable outcome (mRS, 3\u0026ndash;6) at 90 days, 26 (3.3%) subjects developed sICH, and 99 (12.4%) subjects experienced death after EVT (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Compared with the subjects with low SBP trajectory, those in the high trajectory had higher incidence of unfavorable outcome (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.024) but not sICH (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.704) and mortality (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.690) at 90 days. Multivariable-adjusted odds ratio (95% confidence interval [CI]) for 90-d mRS (3\u0026ndash;6) was 2.81 (1.42\u0026ndash;5.57) among subjects in high and low SBP trajectory groups after adjusting for age, sex, medical history, clinical data, occlusion site, ASITN/SIR collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data. However, there was no significant difference between SBP trajectories and the secondary outcomes in multivariable analyses.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\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\u003eClinical outcomes and systolic blood pressure trajectories within 24 hours after endovascular therapy\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eClinical outcomes\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;281)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;463)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;56)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90-d mRS score 3\u0026ndash;6\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvents (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e130 (46.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e235 (50.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37 (66.07)\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\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.024\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eAge- and sex-adjusted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.15 (0.85\u0026ndash;1.56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.33 (1.26\u0026ndash;4.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.026\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariable-adjusted*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.27 (0.91\u0026ndash;1.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.81 (1.42\u0026ndash;5.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymptomatic intracerebral hemorrhage\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvents (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11 (3.91)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13 (2.81)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (3.57)\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\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.704\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eAge- and sex-adjusted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.67 (0.30\u0026ndash;1.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.91 (0.19\u0026ndash;4.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.632\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariable-adjusted*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.59 (0.24\u0026ndash;1.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.79 (0.15\u0026ndash;4.19)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMortality within 90 days\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvents (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31 (11.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e61 (13.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7 (12.50)\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\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.690\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\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\u003eAge- and sex-adjusted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.14 (0.74\u0026ndash;1.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.14 (0.50\u0026ndash;2.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.837\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariable-adjusted*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.16 (0.73\u0026ndash;1.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.20 (0.50\u0026ndash;2.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.857\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eOR, odds ratio; CI, confidence interval; mRS, modified Rankin Scale.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Multivariable-adjusted for age, sex, medical history, clinical data, occlusion site, ASITN/SIR collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data (baseline blood glucose level, hs-CRP, total cholesterol, and low-density lipoprotein).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eIn the subgroup analysis stratified by collateral status, subjects with poor collateral had higher proportions of unfavorable outcome in the high SBP trajectory (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) but not those with good collateral (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.628) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Compared with subjects with low SBP trajectory, those with moderate (OR 2.10, 95%CI, 1.23\u0026ndash;3.57) or high SBP trajectories (OR 6.19, 95%CI, 2.17\u0026ndash;17.67) still had higher risk of unfavorable outcome in the poor collateral group (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) after adjustment, and the interaction effect was significant (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.042). As for secondary outcomes, this trend was not observed in different collateral status.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\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\u003eClinical outcomes of systolic blood pressure trajectories within 24 hours according to collateral status\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\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\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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eClinical outcomes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e\u003cp\u003ePoor collateral (n\u0026thinsp;=\u0026thinsp;366)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"4\" nameend=\"c9\" namest=\"c6\"\u003e\u003cp\u003eGood collateral (n\u0026thinsp;=\u0026thinsp;434)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value for interaction\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;113)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;222)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eLow (n\u0026thinsp;=\u0026thinsp;168)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eModerate (n\u0026thinsp;=\u0026thinsp;241)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eHigh (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eOR (95%CI)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e90-d mRS score 3\u0026ndash;6\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvents (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50 (44.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129 (58.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e24 (77.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e80 (47.62)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e106 (43.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e13 (52.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.628\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge- and sex-adjusted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.78 (1.11\u0026ndash;2.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.83 (1.89\u0026ndash;12.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.80 (0.53\u0026ndash;1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.13 (0.48\u0026ndash;2.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.477\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariable-adjusted*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.10 (1.23\u0026ndash;3.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.19 (2.17\u0026ndash;17.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.93 (0.59\u0026ndash;1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1.56 (0.60\u0026ndash;4.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.522\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymptomatic intracerebral hemorrhage\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvents (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4 (3.54)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9 (4.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2 (6.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e7 (1.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e4 (1.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0 (0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.791\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge- and sex-adjusted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.14 (0.34\u0026ndash;3.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.94 (0.33\u0026ndash;11.37)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.36 (0.10\u0026ndash;1.26)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.276\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.491\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariable-adjusted*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.47 (0.40\u0026ndash;5.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.02 (0.49\u0026ndash;32.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.428\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.25 (0.06\u0026ndash;0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.504\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMortality within 90 days\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\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEvents (%)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14 (12.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30 (13.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6 (19.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e17 (10.12)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e31 (12.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e1 (4.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.603\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.283\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge- and sex-adjusted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.02 (0.54\u0026ndash;1.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.64 (0.63\u0026ndash;4.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.539\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.23 (0.68\u0026ndash;2.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.37 (0.05\u0026ndash;2.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.426\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.305\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariable-adjusted*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.00 (0.51\u0026ndash;1.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.65 (0.57\u0026ndash;4.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.573\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.00 (Ref)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e1.50 (0.78\u0026ndash;2.88)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.41 (0.05\u0026ndash;3.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e0.237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.230\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003eOR, odds ratio; CI, confidence interval; mRS, modified Rankin Scale.\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e*Multivariable-adjusted for age, sex, medical history, clinical data, occlusion site, ASITN/SIR collateral grading, stroke etiology, antihypertensive therapy, time from onset to recanalization, and laboratory data (baseline blood glucose level, hs-CRP, total cholesterol, and low-density lipoprotein).\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study showed heterogeneous SBP trajectory profiles in a prospective cohort of 800 patients with ischemic stroke caused by large-vessel occlusion in the anterior circulation, and 3 distinct SBP trajectories were identified during the first 24 hours after successful recanalization. These trajectory groups were obviously different in relation to risk for functional outcome. The patients with high trajectory were more likely to be correlated with unfavorable outcome. Importantly, subgroup analyses demonstrated that the patients with high and moderate trajectories within 24 hours had the higher risk of worse outcome compared with those with low trajectory in the poor collateral. These findings indicate that maintaining SBP of 112\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6 mmHg within the first 24 hours after successful recanalization may be beneficial to improve the functional outcome in ischemic stroke patients with poor collateral.\u003c/p\u003e\u003cp\u003eMost of patients caused by large-vessel occlusion have elevated BP levels above 140 mmHg in the acute phage of ischemic stroke [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This phenomenon is often considered as a compensatory physiological function to supplement cerebral perfusion for maintaining blood flow in the ischemic lesion [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. BP change, an acute stress response to the neurological deficit, may be affected by decreased baroreceptor sensitivity and damaged central autonomic pathways [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. A recently published study suggested that patients with high maximum SBP in acute stressful conditions had higher risk of unfavorable outcome compared with those with low maximum SBP [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. However, the ENCHANTED2/MT study has demonstrated that intensive control of SBP to lower than 120 mm Hg was harmful in patients who received EVT [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Another study suggested that higher SBP during the first 24 hours was correlated with worse outcome in patients with ischemic stroke after successful recanalization [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In the view of this contradiction, trajectory profiles of SBP fluctuation in ischemic stroke patients may represent the personal response of autonomic nervous system to an ischemic injury [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Patients with high trajectory during the first 24 hours of hospitalization were associated with worse outcome, which might be due to an abnormal response of baroreceptor sensitivity [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Our data showed that SBP change over the first 24 hours followed 3 unique trajectories that improved our knowledge of the association between SBP after EVT and clinical outcomes. SBP trajectory groups exhibited the varied risk of neurological dysfunction.\u003c/p\u003e\u003cp\u003ePatients with high BP (high trajectory) after EVT had an elevated risk of worse outcome compared with those with low trajectory, and a mean SBP of 111 mmHg was associated with favorable outcome after EVT, in line with a previous study [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. However, the previous study showed 5 distinct trajectories during the first 72 hours after EVT which were associated with functional outcome [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These inconsistent trajectories may result from recanalization status and BP time of duration. Generally, higher BP is not required after successful reperfusion which may aggravate brain injury. More importantly, the subsequent damage of cerebral autoregulation impairs the cerebrovascular capacity in the regulation of abnormal BP, and the hyperperfusion caused by high BP further facilitates secondary cerebral damage from cerebral hemorrhage and edema [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Nevertheless, trajectory groups were not associated with sICH and mortality in the present study. We found the significant relationship between BP trajectories and stroke disability. These findings were consistent with previous reports [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. This contradiction indicates that the facilitation of poor outcome by increased SBP may not be mainly mediated by sICH. A report showed that higher mean SBP increased the risk of hemicraniectomy in ischemic stroke patients after EVT [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], and elevated BP was considered to be correlated with cerebral edema [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Therefore, the influence of high BP on stroke outcomes may be partially mediated by cerebral edema after EVT.\u003c/p\u003e\u003cp\u003eConcern on the relationship between post-procedure BP and clinical outcomes in ischemic stroke patients after successful recanalization stratified by collateral status remained infrequent. A recent study suggested that the time of periprocedural mean arterial pressure less than 90 mmHg was positively associated with worse outcome in patients with poor collateral but not in those with good collateral [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Patients with elevated post-procedural SBP had the increased risk of unfavorable outcome in the poor collateral rather than good collateral [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These findings suggest the potential clinical significance of collateral status on BP management at perioperative period. In the present study, similar findings of post-EVT BP were also observed in patients with poor collateral. Therefore, maintaining SBP of 112\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6 mmHg may be beneficial to improve the clinical outcomes in the acute phage of patients with poor collateral after successful recanalization.\u003c/p\u003e\u003cp\u003eExisting evidence could not provide a guidance in BP management for ischemic stroke patients after EVT. Several trials and observational studies have reported a contradictory association of BP control with clinical outcome in patients with successful thrombectomy [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. However, periprocedural BP management is complicated due to absence of uniform profiles of physiology, suggesting a more personalized management of BP. The impact of the personalized factors on post-EVT BP is elusive. Our data showed that an underlying male, history of hypertension, diabetes mellitus, previous stroke, smoking, occlusion site, stroke etiology, antihypertensive therapy, and baseline blood glucose level may be implicated. We observed a higher prevalence of hypertension history among patients with the high SBP trajectory. Furthermore, the high and moderate trajectory groups had higher rates of antihypertensive treatment after EVT. However, the antihypertensive medication did not modify the effect of the BP trajectory on functional outcome.\u003c/p\u003e\u003cp\u003eWhile this multicenter cohort study established precise SBP trajectories and explored the effect of post-procedure BP on outcomes in ischemic stroke patients with successful recanalization based on collateral status, several limitations should be acknowledged. First, this study had no standardized BP management protocol across centers, and it is uncertain in the targets of BP control for patients. Second, while this study included antihypertensive treatment, we did not record the timing of antihypertensive medication. Third, there were higher proportions of large artery atherosclerosis in Chinese populations, further research should perform in western populations to confirm the reproducibility of our findings.\u003c/p\u003e\u003cp\u003eIn summary, this study displays a longitudinal pattern of SBP during the first 24 hours after successful thrombectomy. Patients with ischemic stroke have 3 distinct SBP trajectories that were associated with unfavorable outcome in the poor collateral but not in the good collateral.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eblood pressure\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eSBP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esystolic BP\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEVT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eendovascular therapy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003esICH\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003esymptomatic intracranial hemorrhage\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003emTICI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003emodified Thrombolysis in Cerebral Infarction\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eNIHSS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNational Institutes of Health Stroke Scale\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eECASS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEuropean-Australasian Acute Stroke Study\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASITN/SIR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAmerican Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDSA\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003edigital subtraction angiograph\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eIQR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003einterquartile range\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eASPECTS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAlberta Stroke Program Early CT Score\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOR\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eodds ratio\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003econfidence interval.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eResearch involving Human Participants\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe studies involving human participants were reviewed and approved by the Ethics Committee of Nanjing First Hospital, Nanjing Medical University.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformed consent\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe patients/participants provided their written informed consent to participate in this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDeclaration of Helsinki\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol has been carried out in accordance with the Declaration of Helsinki of the World Medical Association.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Science and Technology Innovation 2030–Major Program of Brain Science and Brain-Inspired Intelligence Research (2021ZD0201807); Nanjing Medical Science and Technology Development Foundation (YKK23111); Medjaden Academy \u0026amp; Research Foundation for Young Scientists (No. MJR202310040 and No. MJR202410130); Nanjing Medical University Science and Technique Development Foundation Project (NMUB20220060); Nanjing Medical Science and Technique Development Foundation Project (ZKX22031); Postgraduate Research \u0026amp; Practice Innovation Program of Jiangsu Province (SJCX24_0763); Key Project of Jiangsu Provincial Youth Talent Program(NO. JSSA2024ZD02).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData curation, ZZL, LFJ, LYZ and SYZ; Formal analysis, ZHH, HQP and YTZ; Investigation, HLS, LZ, YFQ and MMG; Project administration, SL, YDY and QWD; Writing – original draft, QWD; Writing – review \u0026amp; editing, SL, YDY and QWD.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSarraj A, Yoshimura S, Thomalla G, Huo X, Arquizan C, Yoo AJ, et al. Mechanical Thrombectomy for Large Ischemic Stroke: A Critical Appraisal of Evidence From 6 Randomized Controlled Trials. 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Lancet Neurol. 2021;20(4):265\u0026ndash;74. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S1474-4422(20)30483-X\u003c/span\u003e\u003cspan address=\"10.1016/S1474-4422(20)30483-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"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":"blood pressure, endovascular therapy, trajectory, outcome, collateral status","lastPublishedDoi":"10.21203/rs.3.rs-7331436/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7331436/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground and purpose:\u003c/strong\u003e Blood pressure (BP) management in the acute phage of stroke is associated with clinical outcomes among patients with after endovascular therapy (EVT). This study was to explore whether collateral circulation status modified the effect of BP course on clinical outcomes in patients with EVT.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis study enrolled a total of 800 patients with ischemic stroke caused by large-vessel occlusion in the anterior circulation who underwent successful recanalization. Latent mixture modeling was used to determine systolic BP (SBP) trajectories according to 3 SBP measurements during the first 24 hours after EVT. Collateral status prior to EVT was assessed by digital subtracted angiography. Clinical outcomes including stroke disability (modified Rankin Scale 3-6), mortality, and symptomatic intracranial hemorrhage (sICH) were collected 90 days after stroke.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThree SBP trajectories were identified: high (7%), moderate 57.9%, and low (35.1%) SBP. SBP trajectories were independently associated with unfavorable 90-d outcome (\u003cem\u003eP\u003c/em\u003e=0.012) after adjustment. Patients with high and moderate SBP trajectories had had an elevated risk of unfavorable outcome in the poor collateral (adjusted odds ratio, 6.19 [95%CI, 2.17-17.67], \u003cem\u003eP\u003c/em\u003e\u0026lt;0.001 and adjusted odds ratio, 2.10 [95%CI, 1.23-3.57], \u003cem\u003eP\u003c/em\u003e=0.007, respectively) rather than good collateral (\u003cem\u003eP\u003c/em\u003e for interaction: 0.042). There was no significant difference regarding mortality and sICH across SBP trajectories.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003ePatients with high or moderate SBP trajectory during the first 24 hours after successful recanalization had a higher risk of unfavorable outcome among patients with poor collateral.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration:\u003c/strong\u003e https://www.clinicaltrials.gov/ct2/show/NCT04775147; https://www.clinicaltrials.gov/ct2/show/NCT04230785 Unique identifier: NCT04775147 (registered on March 01, 2021) and NCT04230785 (registered on January18, 2020).\u003c/p\u003e","manuscriptTitle":"Pretreatment collateral circulation status modifies the effect of blood pressure trajectory on outcome after endovascular therapy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-22 09:59:20","doi":"10.21203/rs.3.rs-7331436/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":"3e41c015-17ce-4e07-8a89-0e90bbdc79bb","owner":[],"postedDate":"September 22nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-29T07:54:49+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-22 09:59:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7331436","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7331436","identity":"rs-7331436","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}