Impact of intensive blood pressure lowering after multiple-attempt endovascular thrombectomy: A secondary analysis of the OPTIMAL-BP trial
- Author(s)
- Jae Wook Jung; Kwang Hyun Kim; Jaeseob Yun; Young Dae Kim; JoonNyung Heo; Hyungwoo Lee; Jin Kyo Choi; Hyung Lee Il; In Hwan Lim; Soon-Ho Hong; Byung Moon Kim; Dong Joon Kim; Na Young Shin; Bang-Hoon Cho; Seong Hwan Ahn; Hyungjong Park; Sung-Il Sohn; Jeong-Ho Hong; Tae-Jin Song; Yoonkyung Chang; Gyu Sik Kim; Kwon-Duk Seo; Kijeong Lee; Jun Young Chang; Jung Hwa Seo; Sukyoon Lee; Jang-Hyun Baek; Han-Jin Cho; Dong Hoon Shin; Jinkwon Kim; Joonsang Yoo; Minyoul Baik; Kyung-Yul Lee; Yo Han Jung; Yang-Ha Hwang; Chi Kyung Kim; Jae Guk Kim; Chan Joo Lee; Sungha Park; Soyoung Jeon; Hye Sun Lee; Sun U Kwon; Oh Young Bang; Ji Hoe Heo; Hyo Suk Nam
- Alternative Author(s)
- Park, Hyung Jong; Sohn, 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.
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