I recently had a wave of automated account registrations on a Mastodon instance where all generated usernames followed the same predictable pattern:
bp0123456789abcdef
In this case, blocking VPN providers or entire IP ranges turned out to be far too broad. A much cleaner workaround was to reject the abusive username pattern directly during Mastodon's normal account validation.
This is a local source modification, so it will need to be carried forward when upgrading Mastodon.