In ischemic stroke, EVT improved 90-d function more than usual care across admission SBP levels.

Area of Science:

• Neurology
• Cardiovascular Medicine
• Interventional Radiology

Background:

• Endovascular treatment (EVT) is a key therapy for acute ischemic stroke.
• The impact of admission systolic blood pressure (aSBP) on EVT outcomes is not fully understood.
• Existing guidelines offer varied recommendations regarding aSBP thresholds for EVT.

Purpose of the Study:

• To investigate the association between aSBP and the efficacy of EVT in patients with ischemic stroke.
• To determine if aSBP influences the benefit derived from endovascular therapy.
• To provide evidence-based recommendations for EVT in ischemic stroke patients with varying aSBP.

Main Methods:

• Individual patient data meta-analysis of prospective, multi-center studies.
• Inclusion of patients with anterior and posterior circulation ischemic stroke undergoing EVT.
• Statistical analysis to assess the interaction between aSBP and EVT effect on functional outcome.

Main Results:

• No significant interaction was found between aSBP and the effect of EVT on functional outcome (modified Rankin Scale score at 90 days).
• The benefit of EVT was consistent across a wide range of aSBP values.
• Higher aSBP was not associated with reduced treatment effect.

Conclusions:

• Admission systolic blood pressure does not appear to modify the effectiveness of endovascular treatment in patients with ischemic stroke.
• These findings support the administration of EVT in eligible ischemic stroke patients irrespective of their initial systolic blood pressure.
• This meta-analysis provides robust evidence to inform clinical guidelines and treatment decisions for acute stroke management.