Background: Previous guidelines for post-operative blood pressure (BP) management have focused on SBP and DBP in stroke patients who have undergone intravenous thrombolysis (IVT). Whether pulse pressure (PP) affects the prognosis of patients with ischemic stroke after endovascular thrombectomy (EVT) remains an unresolved issue. Methods: In this study, we systematically collected twelve BP parameters within 24 hours after thrombectomy and regularly followed up to assess the mRS scores. We utilized univariate and multivariate logistic regression analyses to identify predictive factors for poor prognosis and morality following EVT. Restrictive cubic splines (RCS) are used to evaluate the dose-effect relationship between PP and outcome events. Subgroup analyses were conducted to assess the prognostic efficacy of mean PP across different patient groups, with a favorable outcome defined as a modified Rankin Scale (mRS) score between 0 and 3 at three months post-EVT. Results: Post-EVT SBP data were available for 587/826 patients. Mean PP demonstrates a significant positive dose-response relationship with the occurrence of functional outcomes, sICH, and mortality after EVT. The predictive power and strength of association of mean PP with prognosis are superior to those of single SBP or DBP alone with the strongest ORs and highest diagnostic performance. Mean PP exhibits a linear relationship with all other outcome events, except for mortality at 12 months post-EVT. Conclusion: The mean PP within 24 hours after EVT is an independent risk factor for sICH, prognosis, and mortality in stroke patients, with a stronger association and diagnostic performance than either SBP or DBP. Achieving consistent long-term control of SBP and PP may be beneficial for improving the prognosis of ischemic stroke patients. Key words: Pulse pressure; ischemic stroke; Endovascular thrombectomy; blood pressure

The authors have declared no competing interest.

This work was financially supported by the National Natural Science Foundation of China (82202407), Natural Science Foundation of Zhejiang Province (LQ21H090008) and Zhejiang medical and health science and technology project (2021434317).

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This large retrospective study was approved by human Research Ethics Committee, the Second Affiliated Hospital of Zhejiang University School of Medicine.

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