계명대학교 의학도서관 Repository

Impact of intensive blood pressure lowering after multiple-attempt endovascular thrombectomy: A secondary analysis of the OPTIMAL-BP trial

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Author(s)
Jae Wook JungKwang Hyun KimJaeseob YunYoung Dae KimJoonNyung HeoHyungwoo LeeJin Kyo ChoiHyung Lee IlIn Hwan LimSoon-Ho HongByung 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 YooMinyoul BaikKyung-Yul LeeYo Han JungYang-Ha HwangChi Kyung KimJae Guk KimChan Joo LeeSungha ParkSoyoung JeonHye Sun LeeSun U KwonOh Young BangJi Hoe HeoHyo Suk Nam
Alternative Author(s)
Park, Hyung JongSohn, Sung Il Hong, Jeong Ho
Department
Dept. of Neurology (신경과학)
Journal Title
Int J Stroke
Issued Date
2024
Volume
19
Number
10
Abstract
Background:
Multiple attempts of thrombectomy have been linked to a higher risk of intracerebral hemorrhage and worsened functional outcomes, potentially influenced by blood pressure (BP) management strategies. Nonetheless, the impact of intensive BP management following successful recanalization through multiple attempts remains uncertain.

Aims:
This study aimed to investigate whether conventional and intensive BP managements differentially affect outcomes according to multiple-attempt recanalization (MAR) and first-attempt recanalization (FAR) groups.

Methods:
In this secondary analysis of the OPTIMAL-BP trial, which was a comparison of intensive (systolic BP target: <140 mm Hg) and conventional (systolic BP target = 140–180 mm Hg) BP managements during the 24 h after successful recanalization, we included intention-to-treat population of the trial. Patients were divided into the MAR and the FAR groups. We examined a potential interaction between the number of thrombectomy attempts (MAR and FAR groups) and the effect of BP managements on clinical and safety outcomes. The primary outcome was functional independence at 3 months. Safety outcomes were symptomatic intracerebral hemorrhage within 36 h and mortality within 3 months.

Results:
Of the 305 patients (median = 75 years), 102 (33.4%) were in the MAR group and 203 (66.6%) were in the FAR group. The intensive BP management was significantly associated with a lower rate of functional independence in the MAR group (intensive, 32.7% vs conventional, 54.9%, adjusted odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12–0.90, p = 0.03). In the FAR group, the proportion of patients with functional independence was not significantly different between the BP managements (intensive, 42.5% vs conventional, 54.2%, adjusted OR = 0.73, 95% CI = 0.38–1.40). Incidences of symptomatic intracerebral hemorrhage and mortality rates were not significantly different according to the BP managements in both MAR and FAR groups.

Conclusions:
Among stroke patients who received multiple attempts of thrombectomy, intensive BP management for 24 h resulted in a reduced chance of functional independence at 3 months and did not reduce symptomatic intracerebral hemorrhage following successful reperfusion.
Affiliated Author(s)
박형종
손성일
홍정호
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1747-4930
Fulltext
https://journals.sagepub.com/doi/10.1177/17474930241265652
DOI
10.1177/17474930241265652
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45857
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Neurology (신경과학)
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