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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Intensive Ambulance-Delivered Blood-Pressure Reduction in Hyperacute Stroke
Gang Li1, Yapeng Lin1, Jie Yang1
1From the Department of Neurology, Shanghai East Hospital, School of Medicine, Tongji University (G.L., C.C., F.L., D.H., Y.Z., L.Z., G.M., Y.Y., J.H., Xiahong Xu, X. Xiong, Y.T.), the Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University (C.S.A., L. Song), Shanghai Pudong New District Medical Emergency Center (C.Z.), the Department of Neurology, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine (F.W.), the Department of Neurology, Shanghai Pudong New District People's Hospital (X.Z.), the Department of Neurology, Gongli Hospital, Pudong New Area (M.J.), and the Department of Neurology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital (Xiaoyun Xu), Shanghai, the First Affiliated Hospital of Chengdu Medical College (Y.L., Y.G., J. Yu, S.L., S.H., F.M., Q.T.), the International Clinical Research Center, Chengdu Medical College (Y.L.), the Department of Neurology (J. Yang, S.T., N.Y., B.L., J.G.), the Institute of Neurology (J. Yang), Sichuan Provincial Key Laboratory for Human Disease Gene Study (J. Yang, S.T.), and the Departments of Neurosurgery (R.X.) and Emergency Medicine (M.S.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, and the First People's Hospital of Shuangliu District, Chengdu/West China (Airport) Hospital Sichuan University (Y.H.), Chengdu, the George Institute for Global Health China, Beijing (C.S.A., C.C., X.R., M.O., L. Song), Zigong Fourth People's Hospital, Zigong (P.X.), Fushun County People's Hospital, Fushun (L.W.), Kaijiang County People's Hospital, Kaijiang (D.Q.), QianWei County People's Hospital, Leshan (Y.P.), Dazhu People's Hospital, Dazhu (C.L.), the Department of Neurology, Yucheng People's Hospital, Yucheng (J.L.), the Department of Neurology, Sixian People's Hospital, Suzhou (Y.W.), Guanghan People's Hospital, Guanghan (X.W.), and the Department of Neurology, Xuzhou Central Hospital, Xuzhou (G.C.) - all in China; the George Institute for Global Health, Faculty of Medicine, University of New South Wales (C.S.A., C.C., L.B., Q.L., X.C., X.L., X.R., L.L., H.L., M.O., L. Song), the Neurology Department, Royal Prince Alfred Hospital (C.S.A.), Menzies Centre for Health Policy and Economics, University of Sydney (H.L.), Sydney Institute for Women, Children and Their Families, Sydney Local Health District (H.L.), and the School of Health Sciences, Western Sydney University (L. Si) - all in Sydney; the Department of Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan (H.A.); the Stroke Trials Unit, Mental Health and Clinical Neuroscience, University of Nottingham, Nottingham (P.M.B.), Radcliffe Department of Medicine, University of Oxford, Oxford (G.A.F., N.S.), and the University of Leicester, Leicester (T.R.) - all in the United Kingdom; the Department of Neurology, Oslo University Hospital, and the Norwegian Air Ambulance Foundation - both in Oslo (E.C.S.); the University of California, Los Angeles, Los Angeles (J.L.S.); and the Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands (H.B.W.).
Early blood-pressure reduction in ambulances did not improve outcomes for undifferentiated acute stroke patients. However, it benefited those with hemorrhagic stroke but worsened outcomes for ischemic stroke patients.
Area of Science:
- Neurology
- Emergency Medicine
- Cardiovascular Research
Background:
- Acute stroke treatment is challenging before differentiating between ischemic and hemorrhagic types.
- The efficacy of very early blood-pressure control in ambulances for undifferentiated acute stroke remains uncertain.
Purpose of the Study:
- To investigate whether immediate prehospital blood-pressure reduction improves functional outcomes in patients with acute stroke.
Main Methods:
- Randomized trial of 2404 patients with suspected acute stroke and elevated systolic blood pressure (≥150 mm Hg).
- Intervention group received immediate blood-pressure lowering (target 130-140 mm Hg) in the ambulance; usual-care group received standard management.
- Primary outcome was functional status (modified Rankin scale) at 90 days; safety outcome was serious adverse events.
Main Results:
- No significant difference in functional outcomes or serious adverse events between groups.
- Prehospital blood-pressure reduction was associated with better outcomes in hemorrhagic stroke but worse outcomes in ischemic stroke.
Conclusions:
- Prehospital blood-pressure reduction did not improve overall functional outcomes in undifferentiated acute stroke patients.
- The strategy showed potential benefit in hemorrhagic stroke but harm in ischemic stroke, highlighting the need for careful patient selection.

