The optimal blood pressure targets before endovascular treatment (EVT) for acute ischemic stroke remain unknown. This study aims to assess the relationship between successful reperfusion post EVT, admission BP and clinical outcomes. The data was gathered from MR CLEAN (Multicenter Randomized Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) Registry. The diastolic BP (DBP) and Baseline systolic BP (SBP) were recorded on admission. The parameter estimates were calculated per 10 mm of Hg decline or rise in BP.

In total, 3180 patients were treated with EVT between 2014-2017. The relations between admission DBP and SBP with 3 month Rankin Scale scores and mortality was J-shaped, with inflection points around 81 and 150 mm Hg, respectively. An increase in SBP above 150 mm Hg was associated with poor functional outcome and mortality at 90 days. Following linear relationships, higher SBP was associated with a lower probability of successful reperfusion and with the occurrence of symptomatic intracranial hemorrhage. Results for the DBP were mostly similar.

In conclusion, association of higher admission SBP and DBP was found to be associated with lower probability of successful reperfusion in patients and poor clinical outcomes with ischemic stroke treated with EVT. The results undermine the potential for pre BP modification in patients that are eligible for EVT, which could focus on randomized controlled trials in future.