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Abstract DP033: Temporal Dynamics of Cerebral Autoregulation After Thrombectomy and Association With Functional Outcomes
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Abstract DP033: Temporal Dynamics of Cerebral Autoregulation After Thrombectomy and Association With Functional Outcomes

Pwint Thinzar, David Vargas, Sithmi Jayasundara, Kaitlyn Stoehr, Emily Gilmore, Jennifer Kim, Guido Falcone, Adam de Havenon, Charles Matouk, Ryan Hebert, …
Stroke (1970), Vol.57(Suppl_1)
02/2026
DOI: 10.1161/str.57.suppl_1.DP033

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Abstract

Introduction: Impaired cerebral autoregulation in large vessel occlusion (LVO) stroke has been associated with poor functional outcomes. However, the evolution of autoregulatory function in the immediate post-mechanical thrombectomy (MT) period has not been well defined. Methods: We conducted a prospective observational study of patients with anterior circulation LVO undergoing MT. To track patients' cerebral autoregulatory function, cerebral oximetry index (COx)-a rolling correlation between mean arterial pressure and near-infrared spectroscopy-derived regional oxygen saturation-was continuously recorded for 24 hours post-procedure. Associations between mean COx and dichotomized 3-month functional outcomes (modified Rankin Scale [mRS] 0-2 vs > 2) were assessed using multivariable logistic regression and adjusted for relevant confounders. Temporal trajectories of COx were compared between hemispheres and stratified by outcome. Results: Among 196 patients (mean age 70.5 ± 16.1 years; admission NIHSS 13.7 ± 6.4), higher mean COx was independently associated with unfavorable outcomes (adjusted OR 1.29 per 0.1 increase; 95% CI 1.03-1.63; p < 0.05). Post-reperfusion, COx values were elevated in both outcome groups. Approximately 4 hours post-MT, patients with favorable outcomes exhibited a significant decline in COx in both hemispheres, whereas those with unfavorable outcomes maintained elevated COx levels. Over 24 hours, COx remained lower in patients with better recovery (Figure 1). Conclusions: Impaired autoregulation, indicated by higher mean COx, is associated with poor functional recovery following MT. Every 0.1 increase in mean COx during the first 24 hours correlates with a 29% higher likelihood of unfavorable outcome. Dysfunction emerges early post-reperfusion and involves both hemispheres, though less severely contralaterally. Tracking autoregulatory recovery may support individualized blood pressure targets and guide interventions to optimize stroke outcomes.
 Neuroendovascular (for stroke) Ischemic stroke

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