Eur Stroke J. 2026 Mar 1;11(3):aakag012. doi: 10.1093/esj/aakag012.
ABSTRACT
INTRODUCTION: Haemorrhagic transformation (HT) seriously worsens functional outcome after endovascular therapy (EVT). Blood pressure (BP) variability may influence HT risk, but optimal monitoring strategies remain unclear. We aimed to determine whether continuous BP monitoring better identifies patients at risk of HT than standard intermittent measurements during the first 24 h post-EVT.
PATIENTS AND METHODS: We conducted a single-centre prospective cohort study including adults with acute ischaemic stroke due to large-vessel occlusion treated with EVT. Non-invasive finger-cuff continuous BP and arm-cuff intermittent BP were recorded simultaneously for 24 h post-EVT. Haemorrhagic transformation on follow-up brain imaging at 24-36 h was the primary outcome. Blood pressure recordings were partitioned into three 8-h windows. Variability metrics (mean, maximum, range, SD, coefficient of variation and wavelet-based coefficient energies) were processed into logistic regression models adjusted for clinical covariates. Predictive performance was assessed using AUC-ROC.
RESULTS: Among 455 enrolled patients, 199 contributed data to the first 8-h window, in which HT occurred in 58 (29%). Continuous BP variability features, particularly maximum, range and wavelet energies capturing < 32-min fluctuations, were significantly associated with HT, whereas no parameter from intermittent monitoring showed such an association. A multivariable model using continuous data yielded an AUC-ROC of 0.62 (95% CI, 0.54-0.71) vs 0.48 (95% CI, 0.37-0.58) for intermittent data. Associations were not observed in later windows.
DISCUSSION AND CONCLUSION: Short-timescale BP variability captured by continuous monitoring in the first 8 h post-EVT is associated with increased HT risk, whereas intermittent monitoring fails to detect this signal and may miss opportunities for early risk stratification.
PMID:41871383 | PMC:PMC13008327 | DOI:10.1093/esj/aakag012