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Background Intensive blood pressure (BP) lowering after successful endovascular thrombectomy (EVT) failed to improve functional outcomes, but its association with the extent of blood-brain barrier disruption remains unclear. We investigated whether Contrast Staining-Alberta Stroke Programme Early CT Score (CS-ASPECTS) and contrast staining (CS) after EVT modify the outcomes of post-EVT BP management strategy.Methods This post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure trial included acute stroke patients who achieved successful EVT and underwent follow-up brain CT within 3 hours of randomisation to intensive (systolic BP <140 mm Hg) or conventional (140–180 mm Hg) BP management. Subgroup analyses were conducted based on CS status and CS-ASPECTS.Results Among 174 patients (mean age 72.8±12.1 years, 38.5% women), CS was present in 123 (70.7%). CS was associated with a higher rate of any intracranial haemorrhage (ICH) but not with functional outcome. CS-ASPECTS 0–6 was associated with a higher risk of symptomatic ICH and worse functional outcome compared with CS-ASPECTS 7–10. Among patients with CS-ASPECTS 7–10, intensive BP lowering was associated with a lower likelihood of functional independence (adjusted OR 0.37, 95% CI 0.15 to 0.87), whereas no significant association was observed in patients with CS-ASPECTS 0–6 (adjusted OR 1.29, 95% CI 0.20 to 9.09) (P for interaction=0.044). There was no significant heterogeneity between BP management strategy and CS-ASPECTS for symptomatic intracerebral haemorrhage or mortality.Conclusions CS-ASPECTS, but not CS alone, was associated with functional outcome and identified heterogeneity in the association between post-EVT BP lowering and functional independence. These exploratory findings warrant prospective validation before clinical application.Trial registration number NCT04205305.