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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Blood Pressure Goals and Clinical Outcomes after Successful Endovascular Therapy: A Multicenter Study

Mohammad Anadani1,2, Adam S Arthur2, Georgios Tsivgoulis3

  • 1Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.

Annals of Neurology
|March 19, 2020
PubMed

Insights

Lowering systolic blood pressure (SBP) after endovascular therapy (EVT) for stroke may improve outcomes. Achieving SBP goals below 160mmHg after successful revascularization (SR) is linked to better functional results and reduced mortality.

Area of Science:

  • Neurology
  • Cardiovascular Medicine
  • Interventional Radiology

Background:

  • Elevated systolic blood pressure (SBP) post-successful revascularization (SR) using endovascular therapy (EVT) predicts poor outcomes in stroke patients.
  • The optimal SBP target following EVT remains undetermined, necessitating research into different SBP goals.

Purpose of the Study:

  • To compare functional and safety outcomes based on varying SBP goals within the first 24 hours after EVT with SR.
  • To investigate the association between different SBP targets and clinical outcomes in stroke patients undergoing EVT.

Main Methods:

  • An international multicenter study involving 8 stroke centers included patients with anterior circulation large vessel occlusion treated with EVT and achieving SR (modified thrombolysis in cerebral ischemia 2b-3).
  • Patients were stratified into three groups based on their SBP goal (<140mmHg, <160mmHg, or <180mmHg) in the initial 24 hours post-EVT.
  • Inverse probability of treatment weighting (IPTW) propensity analysis was employed to evaluate the impact of different SBP goals on clinical outcomes.

Main Results:

  • Analysis of 1,019 patients revealed that an SBP goal of <140mmHg was associated with a higher likelihood of good functional outcome and reduced need for hemicraniectomy compared to an SBP goal of <180mmHg.
  • An SBP goal of <160mmHg demonstrated lower odds of mortality compared to an SBP goal of <180mmHg.
  • Subgroup analysis in patients with pre-EVT SBP ≥140mmHg showed that an SBP goal of <140mmHg correlated with better functional outcomes, fewer symptomatic intracranial hemorrhages, and less need for hemicraniectomy versus an SBP goal of <180mmHg.

Conclusions:

  • Achieving lower SBP goals (<140mmHg or <160mmHg) after successful revascularization with EVT appears to be associated with improved clinical outcomes compared to an SBP goal of <180mmHg.
  • These findings suggest that tighter SBP control may be beneficial in stroke patients following EVT and SR.
Abstract

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