Intensive Blood Pressure Control After Endovascular Thrombectomy for Acute Ischemic Stroke: a Systematic Review and Meta-Analysis

Mohamed Abuelazm; Yehya Khildj; Ahmed A Ibrahim; Abdelrahman Mahmoud; Ahmed Mazen Amin; Ibrahim Gowaily; Ubaid Khan; Basel Abdelazeem; James Robert Brašić

doi:10.1007/s00062-024-01391-6

Intensive Blood Pressure Control After Endovascular Thrombectomy for Acute Ischemic Stroke: a Systematic Review and Meta-Analysis

Clin Neuroradiol. 2024 Mar 7. doi: 10.1007/s00062-024-01391-6. Online ahead of print.

Authors

Affiliations

¹ Faculty of Medicine, Tanta University, Tanta, Egypt.
² Faculty of Medicine, University of Algiers, Algiers, Algeria.
³ Faculty of Medicine, Menoufia University, Menoufia, Egypt. ahmedabdalaziz33@med.menofia.edu.eg.
⁴ Faculty of Medicine, Minia University, Minia, Egypt.
⁵ Faculty of Medicine, Mansoura University, Mansoura, Egypt.
⁶ Faculty of Medicine, King Edward Medical University, Lahore, Pakistan.
⁷ Department of Cardiology, West Virginia University, West Virginia, USA.
⁸ Section of High-Resolution Brain Positron Emission Tomography Imaging, Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Department of Behavioral Health, New York City Health and Hospitals/Bellevue, New York, NY, USA.
¹⁰ Department of Psychiatry, New York University Grossman School of Medicine, New York University Langone Health, New York, NY, USA.

PMID: 38453701
DOI: 10.1007/s00062-024-01391-6

Abstract

Background and purpose: Optimal clinical outcome with successful recanalization from endovascular thrombectomy (EVT) requires optimal blood pressure (BP) management. We aimed to evaluate the efficacy and safety of the intensive BP target (< 140 mm Hg) versus the standard BP target (< 180 mm Hg) after EVT for acute ischemic stroke.

Methods: We conducted a systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and WOS until September 7th, 2023. We used the fixed-effect model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI).

Prospero id: CRD42023463206.

Results: We included four RCTs with 1559 patients. There was no difference between intensive BP and standard BP targets regarding the National Institutes of Health Stroke Scale (NIHSS) change after 24 h [MD: 0.44 with 95% CI (0.0, 0.87), P = 0.05]. However, the intensive BP target was significantly associated with a decreased risk of excellent neurological recovery (mRS ≤ 1) [RR: 0.87 with 95% CI (0.76, 0.99), P = 0.03], functional independence (mRS ≤ 2) [RR: 0.81 with 95% CI (0.73, 0.90), P = 0.0001] and independent ambulation (mRS ≤ 3) [RR: 0.85 with 95% CI (0.79, 0.92), P < 0.0001].

Conclusions: An intensive BP target after EVT is associated with worse neurological recovery and significantly decreased rates of functional independence and independent ambulation compared to the standard BP target. Therefore, the intensive BP target should be avoided after EVT for acute ischemic stroke.

Keywords: Cardiovascular disease; Clinical trial; Function recovery; Intracranial hemorrhage; Meta-analysis; Stroke.