Meta-Analysis of the Safety and Efficacy of Intensive Blood Pressure Control After Thrombectomy

After successful endovascular treatment of acute ischemic stroke, there remains considerable controversy surrounding the efficacy of intensified blood pressure control therapy. Presently, numerous randomized controlled trials have yielded diverse findings. Thus, our objective is to consolidate all current randomized controlled trial data to evaluate whether intensified systolic blood pressure targets, in comparison to standard targets, offer superior safety and efficacy.

By searching the EMBASE, PubMed, and Cochrane Library databases, we identified randomized controlled trials comparing standard blood pressure control to intensified blood pressure control in patients with acute ischemic stroke undergoing endovascular thrombectomy (EVT). Efficacy outcomes included favorable clinical outcomes (defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days), excellence clinical outcomes (defined as an mRS score of 0-1 at 90 days), and 90-day mortality. Safety outcomes included symptomatic intracranial hemorrhage (sICH). The relationship between standard and intensified blood pressure control post-EVT and the prognosis of patients with acute ischemic stroke undergoing endovascular thrombectomy was expressed using risk ratios (RR) and their corresponding 95% confidence intervals (95% CI).

The analysis encompassed four studies involving a total of 753 patients. After sensitivity analysis and exclusion of literature with significant heterogeneity, it was revealed that compared to intensified blood pressure control, standard blood pressure control was associated with excellent clinical outcomes RR of 0.81 (95% confidence interval [CI]: 0.73-0.90; p < 0.05; I²  =  25%). However, no significant correlation was found for favorable clinical outcomes, 90-day mortality, and safety outcomes including symptomatic intracranial hemorrhage.

After careful analysis, our conclusion is that intensified blood pressure control, compared to standard blood pressure control following endovascular treatment in acute stroke patients, does not yield better clinical outcomes and may even lead to inferior ones. Moreover, there is no significant disparity in terms of safety between the two approaches.