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Although unstable systolic blood pressure (SBP) after EVT is recognized as a risk factor for END, it remains unclear whether this association persists after excluding identifiable causes of END. In this prospective, observational cohort study, AIS patients who underwent EVT within 24\u00a0h of stroke onset were included. Invasive arterial blood pressure (BP) monitoring recorded hourly BP readings during the first 24\u00a0h post\u2010EVT. Unexplained END was defined as an increase of \u22654 points in the National Institutes of Health Stroke Scale score 24\u00a0h after EVT without any identifiable cause. Two distinct SBP trajectories\u2014high and low\u2014were identified within 24\u00a0h post\u2010EVT. The high\u2010trajectory group, characterized by elevated mean SBP and increased SBP variability (SBPV), exhibited a significantly higher incidence of unexplained END (odds ratio [OR]\u00a0=\u00a03.28, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.01). SBPV alone was an independent risk factor for unexplained END (OR\u00a0=\u00a01.11, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). Moreover, patients with both higher mean SBP and increased SBPV had a markedly greater risk of unexplained END (OR\u00a0=\u00a013.79, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.05). Notably, the harmful threshold for SBPV was lower during nighttime compared to daytime. These findings suggest that increased SBPV, particularly when combined with elevated mean SBP, significantly heightens the risk of unexplained END post\u2010EVT. Therefore, comprehensive post\u2010EVT blood pressure management should address both absolute BP levels and BPV, with particular emphasis on nighttime monitoring, to optimize early neurological recovery.<\/jats:p>","DOI":"10.1111\/jch.14970","type":"journal-article","created":{"date-parts":[[2025,1,17]],"date-time":"2025-01-17T16:15:07Z","timestamp":1737130507000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Systolic Blood Pressure Trajectories and Variability on Unexplained Early Neurological Deterioration Post\u2010Endovascular Treatment in Acute Ischemic Stroke Patients"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5558-7012","authenticated-orcid":false,"given":"Xuxuan","family":"Gao","sequence":"first","affiliation":[{"name":"Department of Neurology Nanfang Hospital Southern Medical University  Guangzhou Guangdong PR 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Hospital Southern Medical University  Guangzhou Guangdong PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaofei","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Neurology Nanfang Hospital Southern Medical University  Guangzhou Guangdong PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lianghao","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurology Nanfang Hospital Southern Medical University  Guangzhou Guangdong PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Neurology Nanfang Hospital Southern Medical University  Guangzhou Guangdong PR China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiajia","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Neurology Nanfang Hospital Southern Medical University  Guangzhou Guangdong PR 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