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

Abstract

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×age2−2.621×10−5×age2×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.