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Introduction: Observational studies have found an increased risk of hemorrhagic transformation and worse functional outcomes in patients with higher systolic blood pressure variability (BPV). However, the time-varying behavior of BPV after endovascular thrombectomy (EVT) and its effects on functional outcome have not been well characterized., Patients and Methods: We analyzed data from an international cohort of patients with large-vessel occlusion stroke who underwent EVT at 11 centers across North America, Europe, and Asia. Repeated time-stamped blood pressure data were recorded for the first 72 h after thrombectomy. Parameters of BPV were calculated in 12-h epochs using five established methodologies. Systolic BPV trajectories were generated using group-based trajectory modeling, which separates heterogeneous longitudinal data into groups with similar patterns., Results: Of the 2041 patients (age 69 ± 14, 51.4% male, NIHSS 15 ± 7, mean number of BP measurements 50 ± 28) included in our analysis, 1293 (63.4%) had a poor 90-day outcome (mRS ⩾ 3) or a poor discharge outcome (mRS ⩾ 3). We identified three distinct SBP trajectories: low (25%), moderate (64%), and high (11%). Compared to patients with low BPV, those in the highest trajectory group had a significantly greater risk of a poor functional outcome after adjusting for relevant confounders (OR 2.2; 95% CI 1.2-3.9; p  = 0.008). In addition, patients with poor outcomes had significantly higher systolic BPV during the epochs that define the first 24 h after EVT ( p  < 0.001)., Discussion and Conclusions: Acute ischemic stroke patients demonstrate three unique systolic BPV trajectories that differ in their association with functional outcome. Further research is needed to rapidly identify individuals with high-risk BPV trajectories and to develop treatment strategies for targeting high BPV., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Spiotta reports grants and personal fees from Penumbra, grants and personal fees from Stryker, grants from Medtronic, non-financial support from RAPID, personal fees from Terumo, and personal fees from Cerenovus outside the submitted work. Dr. Liman reports personal fees from Stryker outside the submitted work. Dr. de Havenon reports grants from AMAG and grants from Regeneron outside the submitted work. Dr. Ortega-Gutierrez reports grants from Stryker, IschemiaView, Viz.ai, and Siemens; personal fees from Medtronic and personal fees from Stryker outside the submitted work. Dr. Sheth reports grants from NIH, grants from AHA, grants from Hyperfine, grants from Biogen, grants from Zoll, and other support from Alva outside the submitted work., (© European Stroke Organisation 2022.)