VARIANCE: Variability of Assessed BP Readings In Acute Neuro-intervention Cases and its Effect on outcomes

Blood pressure variability (BPV) following endovascular thrombectomy (EVT) in AIS has been associated with poor outcome. Variables that predict high BPV must be examined to improve outcome. The purpose of this study is to analyze predictors and effect of BPV on outcome in patients with good recanalization after EVT. We conducted a retrospective analysis of prospectively collected data from an IRB approved registry of two academic Comprehensive Stroke Centers between 2017-2022. Patients were included if they had 1) anterior circulation large vessel occlusions (LVO) and 2) EVT with TICI 2b-3. All BPs were recorded as immediate pre-op SBP/DBP (one minute prior to procedure), immediate post-op SBP/DBP (at time of recanalization), and 24 hours post revascularization. Demographic variables, stroke time metrics, and symptomatic ICH (sICH) were assessed. Outcome included discharge disposition and 90 day modified Rankin Scale. Good short-term outcome was disposition to home/acute rehabilitation and good long-term outcome was mRS 0-2. BPV was the average of the differences between measurements divided by the number of measurements. We identified 253 patients (mean age 70±14, 51.4% female, 49% white, 30.4% Hispanic). Median NIHSS was 17±8 and mean onset to groin puncture was 478±326 mins. Mean door to groin puncture was 86±110 mins. Good discharge occurred in 58.9% of patients. Mean BPV was 30.6±25.6mmHg and was significantly correlated with female sex, home antihypertensive use, and immediate pre and post-op SBP. BPV was not associated with age, initial NIHSS, Hispanic ethnicity, HTN, sICH, discharge disposition or 90 day mRS. There was a significant correlation of high BPV with female sex and home antihypertensives use. BPV was not correlated with short or long term outcome in this population, however, BPV was lower than prior populations. Assessment of BPV in various stroke centers and populations is necessary to understand the effect of BPV on stroke outcome. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding was received for this study. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: UC San Diego Institutional Review Board I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes De-identied data is available upon request