DOI: 10.1161/svin.124.001678 ISSN: 2694-5746

Association Between Estimated Pulse Wave Velocity and Endovascular Thrombectomy Outcome: A Secondary Analysis of the OPTIMAL‐BP Trial

Minho Han, Haram Joo, Hyungwoo Lee, JoonNyung Heo, Jae Wook Jung, Young Dae Kim, Eunjeong Park, Kwang Hyun Kim, Jaeseob Yun, Jin Kyo Choi, Il Hyung Lee, Byung Moon Kim, Dong Joon Kim, Na Young Shin, Bang‐Hoon Cho, Seong Hwan Ahn, Hyungjong Park, Sung‐Il Sohn, Jeong‐Ho Hong, Tae‐Jin Song, Yoonkyung Chang, Gyu Sik Kim, Kwon‐Duk Seo, Kijeong Lee, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang‐Hyun Baek, Han‐Jin Cho, Dong Hoon Shin, Jinkwon Kim, Joonsang Yoo, Minyoul Baik, Kyung‐Yul Lee, Yo Han Jung, Yang‐Ha Hwang, Chi Kyung Kim, Jae Guk Kim, Chan Joo Lee, Sungha Park, Soyoung Jeon, Hye Sun Lee, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam,
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BACKGROUND

The link between arterial stiffness, measured by estimated pulse wave velocity (ePWV), and outcomes following endovascular thrombectomy (EVT) has not been tested. This study aimed to determine whether ePWV predicts post‐EVT outcome in patients with acute ischemic stroke.

METHODS

This was a secondary analysis of the OPTIMAL‐BP (Outcome in Patients Treated With Intraarterial Thrombectomy–Optimal Blood Pressure Control) trial, which enrolled 302 EVT patients from 19 stroke centers in South Korea between June 18, 2020 and November 28, 2022. The ePWV was calculated using a regression equation based on age and mean blood pressure (BP) at trial enrollment: ePWV = 9.587−0.402×age+4.560×10 −3 ×age 2 −2.621×10 −5 ×age 2 ×mean BP+3.176×10 −3 ×age×mean BP−1.832×10 −2 ×mean BP. The primary outcome was functional independence at 3 months, defined as a modified Rankin Scale score of 0–2. Logistic, ordinal, or linear regression analyses were employed to estimate adjusted odds ratios with 95% CIs for outcomes per 1 m/s or quartile ePWV increase.

RESULTS

Among 302 patients (mean age 73.1±11.5 years, 59.6% men), higher ePWV was independently associated with a lower likelihood of functional independence at 3 months (adjusted odds ratio, 0.80 [95% CI, 0.68–0.94] per 1 m/s increase; adjusted odds ratio, 0.36 [95% CI, 0.14–0.95] for the fourth quartile). A reduction in ePWV at 24 hours after EVT increased the likelihood of functional independence at 3 months in patients receiving conventional BP management (adjusted odds ratio, 3.41 [95% CI, 1.02‒11.38]) but not in those receiving intensive BP management. Incorporating ePWV significantly improved prognostic model performance, with net reclassification improvement of 0.28 (95% CI, 0.06–0.50) and integrated discrimination improvement of 0.02 (95% CI, 0.003–0.04).

CONCLUSION

The ePWV independently predicts functional independence after EVT, suggesting its potential as a practical prognostic indicator using age and baseline BP.

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