Blood pressure targets after successful reperfusion in mechanical thrombectomy for acute ischemic stroke: an updated systematic review and meta-analysis of randomized clinical trials

Edgar Paulo da Silva Neto; Lucas Fernandes Ferreira; Ana Luisa Carvalho de Cardozo Hernandez; Eberval Gadelha Figueiredo; João Paulo Mota Telles

doi:10.1007/s10072-024-07458-z

Blood pressure targets after successful reperfusion in mechanical thrombectomy for acute ischemic stroke: an updated systematic review and meta-analysis of randomized clinical trials

Neurol Sci. 2024 Mar 18. doi: 10.1007/s10072-024-07458-z. Online ahead of print.

Authors

Edgar Paulo da Silva Neto¹, Lucas Fernandes Ferreira², Ana Luisa Carvalho de Cardozo Hernandez², Eberval Gadelha Figueiredo³, João Paulo Mota Telles⁴

Affiliations

¹ Emergency Department, Hospital Geral de Areias, Recife, Brazil.
² Department of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
³ Division of Neurosurgery, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
⁴ Department of Neurology, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil. joao.telles@fm.usp.br.

PMID: 38494461
DOI: 10.1007/s10072-024-07458-z

Abstract

Background: This study sought to determine whether intensive blood pressure (BP) control for patients with successful reperfusion following acute ischemic stroke (AIS) is beneficial, compared to conventional BP management.

Methods: PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) on the subject. The studied outcomes included dependency or death at 90 days (modified Rankin Scale [mRS] 3-6); severe disability at 90 days (mRS 3-5); mortality at 90 days; and symptomatic intracranial hemorrhage. Odds ratios (OR) with 95% confidence intervals were used to compare the treatment effects for categorical outcomes. We employed a fixed-effect model for analyses with low heterogeneity (I² < 25%) and a random-effects model for analyses with higher heterogeneity.

Results: A total of 1519 patients were included, with 50% (n = 760) receiving intensive BP control (systolic BP < 140 mmHg). Functional disability or death at 90 days was significantly higher in the intensive group (54.9%) compared to the conventional treatment group (44.1%) (OR = 1.51; 95% Confidence Interval [CI]: 1.15-1.96; p = 0.003; I² = 29%). Severe functional disability (mRS 3-5) was significantly higher in the intensive group (30.6% vs. 43.5%, OR = 1.75; 95%CI = 1.36-2.25; p < 0.0001; I² = 0%). There was no difference in symptomatic intracranial hemorrhage (OR = 1.13; 95%CI = 0.76-1.67) or mortality (OR = 1.22; 95%CI = 0.9-1.64).

Conclusions: Intensive BP control is harmful in patients who underwent EVT for AIS and achieved successful reperfusion. It yields higher rates of functional dependence, with no differences in mortality or symptomatic intracranial hemorrhage.

Keywords: Blood pressure; Ischemic stroke; Reperfusion; Thrombectomy.