{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:30:25Z","timestamp":1787574625160,"version":"build-2736575974"},"reference-count":25,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T00:00:00Z","timestamp":1787443200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Endovascular thrombectomy (EVT) has transformed the treatment of acute ischaemic stroke due to large-vessel occlusion, yet peri-procedural haemodynamic instability may compromise penumbral perfusion and neurological recovery. We assessed the frequency, determinants and clinical consequences of post-procedural hypotension after EVT. Methods: We retrospectively reviewed 201 consecutive adults who underwent endovascular thrombectomy for anterior-circulation large-vessel occlusion at a single tertiary centre over a period of eight years, from 1 January 2017 to 31 January 2025. Post-procedural hypotension was defined as hypotension requiring initiation of a continuous noradrenaline infusion within 24 h of the procedure. Comorbidities, anaesthetic modality (general anaesthesia [GA] or conscious sedation [CS]), National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores, and in-hospital mortality were recorded. Logistic regression identified independent predictors of hypotension. Results: Fifty-five patients (27.4%) developed post-procedural hypotension. They presented with more severe strokes (NIHSS 16.0 \u00b1 5.0 vs. 13.7 \u00b1 5.0; p = 0.002), had higher NIHSS scores at day 2 (14.0 \u00b1 6.9 vs. 9.4 \u00b1 6.7; p &lt; 0.001) and day 7 (p = 0.003), and displayed markedly higher in-hospital mortality (50.9% vs. 20.5%; p &lt; 0.001). In an ordinal analysis of the day 7 modified Rankin Scale with death coded as 6, hypotension was associated with a shift towards greater disability (common OR 2.57, 95% CI 1.40\u20134.72; p = 0.002). In an exploratory model, each additional 10 min of door-to-groin time was independently associated with hypotension (adjusted OR 1.10, 95% CI 1.03\u20131.18; p = 0.003). Independent predictors of hypotension were baseline NIHSS (adjusted OR 1.11 per point, 95% CI 1.04\u20131.19; p = 0.003) and active malignancy (adjusted OR 2.90, 95% CI 1.04\u20138.09; p = 0.042). Hypotension occurred with similar frequency under GA and CS (28.6% vs. 24.6%; adjusted OR 1.12, 95% CI 0.54\u20132.34; p = 0.766). Conclusions: Post-EVT hypotension is common and associated with poorer early neurological recovery and a more than two-fold higher in-hospital mortality rate. Its independent predictors were baseline stroke severity and active malignancy. Patients with severe stroke or active cancer may warrant intensified haemodynamic surveillance after thrombectomy. Procedural delay emerged as the only modifiable predictor identified and warrants prospective evaluation.<\/jats:p>","DOI":"10.3390\/jcm15176521","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:47:19Z","timestamp":1787572039000},"page":"6521","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hypotension Requiring Vasopressor Support After Endovascular Thrombectomy: Predictors and Neurological Consequences"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2376-0059","authenticated-orcid":false,"given":"Justyna","family":"Zieli\u0144ska-Turek","sequence":"first","affiliation":[{"name":"Department of Neurology, National Medical Institute of the Ministry of the Interior and Administration, 137 Wo\u0142oska Str., 02-507 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dariusz","family":"Kosior","sequence":"additional","affiliation":[{"name":"Mossakowski Medical Research Institute, Polish Academy of Sciences, 02-106 Warsaw, Poland"},{"name":"Department of Sports Medicine, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland"},{"name":"Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 00-416 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jolanta","family":"Ko\u0142akowska","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Medical Institute of the Ministry of the Interior and Administration, 137 Wo\u0142oska Str., 02-507 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8823-1887","authenticated-orcid":false,"given":"Ma\u0142gorzata","family":"Dorobek","sequence":"additional","affiliation":[{"name":"Department of Neurology, National Medical Institute of the Ministry of the Interior and Administration, 137 Wo\u0142oska Str., 02-507 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1016\/S0140-6736(16)00163-X","article-title":"Endovascular thrombectomy after large-vessel ischaemic stroke: A meta-analysis of individual patient data from five randomised trials","volume":"387","author":"Goyal","year":"2016","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Peng, T.J., Ortega-Guti\u00e9rrez, S., de Havenon, A., and Petersen, N.H. (2021). Blood pressure management after endovascular thrombectomy. Front. Neurol., 12.","DOI":"10.3389\/fneur.2021.723461"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1177\/23969873231211157","article-title":"Association between blood-pressure variability and outcomes after endovascular thrombectomy for acute ischaemic stroke: An individual patient data meta-analysis","volume":"9","author":"Palaiodimou","year":"2024","journal-title":"Eur. Stroke J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Wi\u0105cek, M., Szyma\u0144ski, M., Walewska, K., and Bartosik-Psujek, H. (2022). Blood pressure changes during mechanical thrombectomy for acute ischaemic stroke are associated with serious early treatment complications: Symptomatic intracerebral haemorrhage and malignant brain oedema. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.884519"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1016\/S0140-6736(22)01882-7","article-title":"Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2\/MT): A multicentre, open-label, blinded-endpoint, randomised controlled trial","volume":"400","author":"Yang","year":"2022","journal-title":"Lancet"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.neurol.2021.09.012","article-title":"Endovascular therapy for acute ischaemic stroke: The importance of blood pressure control, sedation modality and anti-thrombotic management to improve functional outcomes","volume":"178","author":"Robichon","year":"2022","journal-title":"Rev. Neurol."},{"key":"ref_8","first-page":"859","article-title":"Anaesthesia and haemodynamic management of acute ischaemic stroke patients before, during and after endovascular therapy","volume":"39","author":"Valent","year":"2020","journal-title":"Anaesth. Crit. Care Pain Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1136\/neurintsurg-2017-012988","article-title":"A decrease in blood pressure is associated with unfavourable outcome in patients undergoing thrombectomy under general anaesthesia","volume":"10","author":"Treurniet","year":"2018","journal-title":"J. Neurointerv. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2678","DOI":"10.1161\/STROKEAHA.115.009808","article-title":"Hypotension during endovascular treatment of ischaemic stroke is a risk factor for poor neurological outcome","volume":"46","author":"Rentzos","year":"2015","journal-title":"Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1001\/jama.2016.16623","article-title":"Effect of conscious sedation vs general anaesthesia on early neurological improvement among patients with ischaemic stroke undergoing endovascular thrombectomy: A randomised clinical trial","volume":"316","author":"Uhlmann","year":"2016","journal-title":"JAMA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1001\/jamaneurol.2017.4474","article-title":"Effect of general anaesthesia and conscious sedation during endovascular therapy on infarct growth and clinical outcomes in acute ischaemic stroke: A randomised clinical trial","volume":"75","author":"Simonsen","year":"2018","journal-title":"JAMA Neurol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1601","DOI":"10.1161\/STROKEAHA.117.016554","article-title":"General anesthesia versus conscious sedation for endovascular treatment of acute ischaemic stroke: The AnStroke trial (Anesthesia during stroke)","volume":"48","author":"Rentzos","year":"2017","journal-title":"Stroke"},{"key":"ref_14","first-page":"CD013690","article-title":"Type of anaesthesia for acute ischaemic stroke endovascular treatment","volume":"7","author":"Tosello","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2964","DOI":"10.1161\/STROKEAHA.121.034542","article-title":"Association of hypotension during thrombectomy and outcomes differs with posterior communicating artery patency","volume":"52","author":"Maier","year":"2021","journal-title":"Stroke"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1016\/j.bja.2019.01.013","article-title":"Perioperative Quality Initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery","volume":"122","author":"Sessler","year":"2019","journal-title":"Br. J. Anaesth."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1097\/01.anes.0000270724.40897.8e","article-title":"Incidence of intraoperative hypotension as a function of the chosen definition: Literature definitions applied to a retrospective cohort using automated data collection","volume":"107","author":"Bijker","year":"2007","journal-title":"Anesthesiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"79","DOI":"10.7555\/JBR.31.20160167","article-title":"What is \u2018normal\u2019 intra-operative blood pressure and do deviations from it really affect postoperative outcome?","volume":"31","author":"Li","year":"2017","journal-title":"J. Biomed. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e993","DOI":"10.1212\/WNL.0000000000013316","article-title":"Clinical outcome after endovascular treatment in patients with active cancer and ischemic stroke: A MR CLEAN Registry substudy","volume":"98","author":"Verschoof","year":"2022","journal-title":"Neurology"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Duan, L., Fu, Z., Zhao, H., Song, C., Tian, Q., Dmytriw, A.A., Regenhardt, R.W., Sun, Z., Guo, X., and Wang, X. (2022). Outcomes after endovascular thrombectomy for acute ischemic stroke patients with active cancer: A systematic review and meta-analysis. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.992825"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Wi\u0105cek, M., Tomaszewska-Lampart, I., Dziedzic, M., Kaczorowska, A., and Bartosik-Psujek, H. (2024). Association between transient-continuous hypotension during mechanical thrombectomy for acute ischaemic stroke and final infarct volume in patients with proximal anterior-circulation large-vessel occlusion. J. Clin. Med., 13.","DOI":"10.3390\/jcm13133707"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1159\/000499973","article-title":"Predictors of acute neurological worsening after endovascular thrombectomy","volume":"8","author":"Soomro","year":"2020","journal-title":"Interv. Neurol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2448","DOI":"10.1161\/STROKEAHA.118.024687","article-title":"Blood Pressure and Outcome After Mechanical Thrombectomy with Successful Revascularization: A Multicenter Study","volume":"50","author":"Anadani","year":"2019","journal-title":"Stroke"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e291","DOI":"10.1212\/WNL.0000000000013049","article-title":"Blood pressure after endovascular thrombectomy and outcomes in patients with acute ischaemic stroke: An individual patient data meta-analysis","volume":"98","author":"Katsanos","year":"2022","journal-title":"Neurology"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1161\/STROKEAHA.119.027549","article-title":"Blood pressure variability and neurologic outcome after endovascular thrombectomy: A secondary analysis of the BEST study","volume":"51","author":"Mistry","year":"2020","journal-title":"Stroke"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6521\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T12:09:23Z","timestamp":1787573363000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,23]]},"references-count":25,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176521"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176521","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,23]]}}}