계명대학교 의학도서관 Repository

Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke: The OPTIMAL-BP Randomized Clinical Trial

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Author(s)
Hyo Suk NamYoung Dae KimJoonNyung HeoHyungwoo LeeJae Wook JungJin Kyo ChoiIl Hyung LeeIn Hwan LimSoon-Ho HongMinyoul BaikByung Moon KimDong Joon KimNa-Young ShinBang-Hoon ChoSeong Hwan AhnHyungjong ParkSung-Il SohnJeong-Ho HongTae-Jin SongYoonkyung ChangGyu Sik KimKwon-Duk SeoKijeong LeeJun Young ChangJung Hwa SeoSukyoon LeeJang-Hyun BaekHan-Jin ChoDong Hoon ShinJinkwon KimJoonsang YooKyung-Yul LeeYo Han JungYang-Ha HwangChi Kyung KimJae Guk KimChan Joo LeeSungha ParkHye Sun LeeSun U KwonOh Young BangCraig S AndersonJi Hoe Heo
Keimyung Author(s)
Park, Hyung JongSohn, Sung IlHong, Jeong Ho
Department
Dept. of Neurology (신경과학)
Journal Title
JAMA
Issued Date
2023
Volume
330
Issue
9
Keyword
ClinicalTrials.gov Identifier: NCT04205305.
Abstract
Importance:
Optimal blood pressure (BP) control after successful reperfusion with endovascular thrombectomy (EVT) for patients with acute ischemic stroke is unclear.

Objective:
To determine whether intensive BP management during the first 24 hours after successful reperfusion leads to better clinical outcomes than conventional BP management in patients who underwent EVT.

Design, setting, and participants:
Multicenter, randomized, open-label trial with a blinded end-point evaluation, conducted across 19 stroke centers in South Korea from June 2020 to November 2022 (final follow-up, March 8, 2023). It included 306 patients with large vessel occlusion acute ischemic stroke treated with EVT and with a modified Thrombolysis in Cerebral Infarction score of 2b or greater (partial or complete reperfusion).

Interventions:
Participants were randomly assigned to receive intensive BP management (systolic BP target <140 mm Hg; n = 155) or conventional management (systolic BP target 140-180 mm Hg; n = 150) for 24 hours after enrollment.

Main outcomes and measures:
The primary outcome was functional independence at 3 months (modified Rankin Scale score of 0-2). The primary safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and death related to the index stroke within 3 months.

Results:
The trial was terminated early based on the recommendation of the data and safety monitoring board, which noted safety concerns. Among 306 randomized patients, 305 were confirmed eligible and 302 (99.0%) completed the trial (mean age, 73.0 years; 122 women [40.4%]). The intensive management group had a lower proportion achieving functional independence (39.4%) than the conventional management group (54.4%), with a significant risk difference (-15.1% [95% CI, -26.2% to -3.9%]) and adjusted odds ratio (0.56 [95% CI, 0.33-0.96]; P = .03). Rates of symptomatic intracerebral hemorrhage were 9.0% in the intensive group and 8.1% in the conventional group (risk difference, 1.0% [95% CI, -5.3% to 7.3%]; adjusted odds ratio, 1.10 [95% CI, 0.48-2.53]; P = .82). Death related to the index stroke within 3 months occurred in 7.7% of the intensive group and 5.4% of the conventional group (risk difference, 2.3% [95% CI, -3.3% to 7.9%]; adjusted odds ratio, 1.73 [95% CI, 0.61-4.92]; P = .31).

Conclusions and relevance:
Among patients who achieved successful reperfusion with EVT for acute ischemic stroke with large vessel occlusion, intensive BP management for 24 hours led to a lower likelihood of functional independence at 3 months compared with conventional BP management. These results suggest that intensive BP management should be avoided after successful EVT in acute ischemic stroke.
Keimyung Author(s)(Kor)
박형종
손성일
홍정호
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1538-3598
Source
https://jamanetwork.com/journals/jama/fullarticle/2808993
DOI
10.1001/jama.2023.14590
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45265
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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