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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

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Author(s)
Hyungjong ParkSung-Il SohnGwang Hyun LeemMinho KimYun Hak KimTae-Jin Song
Keimyung Author(s)
Park, Hyung JongSohn, Sung Il
Department
Dept. of Neurology (신경과학)
Journal Title
J Stroke
Issued Date
2024
Volume
26
Issue
1
Keyword
Blood pressureEndovascular therapyMeta-analysisRecanalizationStroke
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.
Keimyung Author(s)(Kor)
박형종
손성일
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
2287-6405
Source
https://j-stroke.org/journal/view.php?doi=10.5853/jos.2023.04119
DOI
10.5853/jos.2023.04119
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45350
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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