J Stroke.  2024 Jan;26(1):54-63. 10.5853/jos.2023.04119.

Standard Versus Intensive Blood Pressure Control in Acute Ischemic Stroke Patients Successfully Treated With Endovascular Thrombectomy: A Systemic Review and Meta-Analysis of Randomized Controlled Trials

• Park H
• Sohn SI
• Leem GH
• Kim M
• Kim YH
• Song TJ

• KMID: 2551347
• DOI: http://doi.org/10.5853/jos.2023.04119

Abstract

Background and Purpose
The optimal blood pressure (BP) control after successful endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) with large vessel occlusion (LVO) remains debatable. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy and safety of standard BP control (with systolic BP ≤180 mm Hg) versus intensive BP control (systolic BP <140 mm Hg) during the 24 hours after successful EVT in AIS with LVO.
Methods
PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant trials. The crude odds ratio (OR) and 95% confidence interval (CI) were calculated and estimates using random-effects models were pooled. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD42023450673).
Results
Four RCTs involving 1,559 participants were included. Regarding efficacy outcomes, intensive BP control was associated with a lower likelihood of functional independence (OR: 0.68; 95% CI: 0.51–0.91 for modified Rankin Scale [mRS] ≤2) and walking without assistance (OR: 0.65; 95% CI: 0.53–0.81 for mRS ≤3). For safety outcomes, consistent with the efficacy findings, intensive BP control was significantly associated with severe disability or death (mRS 5 or 6) (OR: 1.34; 95% CI: 1.07–1.69). However, there were no significant differences including all-cause mortality, any intracerebral hemorrhage (ICH), symptomatic ICH, parenchymal hematoma type 2, and stroke recurrence.
Conclusion
While all four RCTs were conducted to demonstrate the superiority of intensive BP control over standard BP control, standard BP control may be beneficial for the outcome after EVT for AIS with LVO without increasing adverse safety outcomes. Caution should be needed with the application of intensive BP control during the 24 hours following successful recanalization after EVT.

Keyword

Blood pressure; Endovascular therapy; Meta-analysis; Recanalization; Stroke

Figure

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  Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart.

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  Figure 2. Forest plot of the efficacy outcomes [20,26-28]. (A) Functional independence (mRS≤2). (B) Walking without assistance (mRS≤3). (C) Minimally or no disability (mRS ≤1). (D) NIHSS change at 24 hours after endovascular thrombectomy. mRS, modified Rankin Scale; NIHSS, National Institutes of Health Stroke Scale; EVT, endovascular thrombectomy; CI, confidence interval.

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  Figure 3. Forest plot of the safety outcomes [20,26-28]. (A) Severe disability or death (mRS 5 or 6). (B) All-cause mortality. (C) Any intracerebral hemorrhage. (D) Symptomatic intracerebral hemorrhage. mRS, modified Rankin Scale; ICH, intracerebral hemorrhage; CI, confidence interval. (E) Parenchymal hematoma type 2 (PH2). (F) Stroke recurrence. CI, confidence interval.

Reference

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