Journal article
Autoregulation-Guided Blood Pressure Targets After Stroke Thrombectomy: Impact on Secondary Brain Injury and Neurologic Outcomes
Neurology, Vol.106(3), e214577
02/10/2026
DOI: 10.1212/WNL.0000000000214577
PMCID: PMC12952690
PMID: 41512207
Abstract
The optimal blood pressure (BP) target after endovascular thrombectomy (EVT) remains elusive. The aim of our study was to assess the relationship between individualized autoregulation-based BP thresholds, secondary brain injury, and functional outcomes.
We conducted a prospective observational study of patients with acute ischemic stroke who underwent EVT. Simultaneous recordings of arterial BP and near-infrared spectroscopy were used to continuously monitor each patient's limits of autoregulation for up to 24 hours. Time outside limits of autoregulation was correlated with short-term clinical end points, radiographic biomarkers of secondary brain injury, and functional outcomes.
Personalized BP targets were successfully computed in 199 patients. Percent time outside limits of autoregulation was independently associated with early neurologic deterioration (OR 1.2, 95% CI 1.1-1.4,
< 0.001) and worse modified Rankin Scale scores at 90 days (OR 1.22, 95% CI 1.09-1.36,
< 0.001). Patients with hemorrhagic transformation and symptomatic intracranial hemorrhage spent significantly more time above the upper limit of autoregulation compared with those without (18.7% vs 11%,
= 0.02, and 24.9% vs 12.3%,
= 0.024, respectively). Furthermore, time above the upper limit of autoregulation was correlated with net water uptake, a radiographic biomarker of cerebral edema (β = 1.6, 95% CI 0.4-2.8,
= 0.009). In nonrecanalized patients, every 60 minutes below the lower limit of autoregulation was associated with an infarct progression of 16.2 mL (
< 0.001).
Deviations from personalized BP targets were associated with an increased risk of secondary brain injury and worse functional outcomes. The study proposes autoregulation-oriented BP management as a promising strategy for improving recovery after ischemic stroke.
Details
- Title: Subtitle
- Autoregulation-Guided Blood Pressure Targets After Stroke Thrombectomy: Impact on Secondary Brain Injury and Neurologic Outcomes
- Creators
- Nils H Petersen - Yale UniversityLiza Begunova - Yale UniversityMadelynne Olexa - Yale UniversityAtul Kumar - Washington University in St. LouisYasheng Chen - Washington University in St. LouisRajat Dhar - Washington University in St. LouisGuido J Falcone - Yale UniversityEmily J Gilmore - Yale UniversityJennifer Ahjin Kim - Yale UniversityJessica R Magid-Bernstein - Yale UniversityAdam de Havenon - Yale UniversityRandolph S Marshall - Columbia UniversityEliza C Miller - Columbia UniversityCharles Matouk - Yale UniversityRyan Hebert - Yale UniversityKevin N Sheth - Yale UniversitySantiago Ortega-Gutierrez - University of Iowa Hospitals and Clinics
- Resource Type
- Journal article
- Publication Details
- Neurology, Vol.106(3), e214577
- DOI
- 10.1212/WNL.0000000000214577
- PMID
- 41512207
- PMCID
- PMC12952690
- NLM abbreviation
- Neurology
- ISSN
- 1526-632X
- eISSN
- 1526-632X
- Publisher
- American Acadey of Neurology
- Grant note
- NIH: NINDS K23NS110980
This work was supported by the NIH. Its contents are solely the authors' responsibility and do not necessarily represent the official view of NIH (NINDS K23NS110980).
- Language
- English
- Date published
- 02/10/2026
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9985116812302771
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