Effect of Blood Pressure Control on Prognosis in Patients with Acute Ischemic Stroke After Thrombectomy: A Systematic Review and a Meta-Analysis

Introduction Blood pressure control is critical in acute ischemic stroke patients undergoing thrombectomy. Fluctuations in blood pressure can compromise cerebral reperfusion and influence 90-day functional prognosis. However, the relationship between blood pressure and prognosis remains unclear. Objective To examine the impact of blood pressure control strategies on 90-day functional prognosis, intracranial hemorrhage, mortality, and neurological deterioration in patients with acute ischemic stroke following thrombectomy. Method We systematically searched major Chinese/English databases up to April 2025 for interventional studies on post-thrombectomy blood pressure management in acute ischemic stroke. Dual-reviewer screening with predefined criteria identified eligible studies. Cochrane Risk of Bias Tool assessed methodological quality. Data extraction and random-effects meta-analysis (RevMan 5.1) evaluated pooled risk ratios (95% confidence intervals), with heterogeneity quantified via I 2 statistics. Results This meta-analysis of 12 studies ( n = 4,794) found no significant benefit of intensive over standard blood pressure lowering in functional recovery, hemorrhagic risk, mortality, or early neurological outcomes post-thrombectomy. However, subgroup analyses revealed critical associations: lower systolic blood pressure correlated with functional independence (−4.46 mmHg), while elevated levels were linked to intracranial hemorrhage (+6.55 mmHg) and mortality (+3.12 mmHg). Conclusion The meta-analysis findings suggest that individualized blood pressure thresholds, rather than uniform intensive control, may optimize postintervention outcomes, warranting further prospective validation.