OPTIMAL- BP ランダム化臨床試験

Hyo Suk Nam¹, Young Dae Kim¹, JoonNyung Heo¹

¹Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.

JAMA

|September 5, 2023

まとめ

急性性不全性脳卒中における血管内血栓切除術 (EVT) の後の集中血圧管理は,従来の管理と比較して3ヶ月で機能的独立性を低下させた. これは,EVT後の強烈な血圧制御を避けることを示唆しています.

科学分野:

神経学
心臓病科
クリティカルケア医療

背景:

急性不全性脳卒中における血管内血栓切除術 (EVT) の後の最適の血圧管理は未定である.
効果的BP制御は,再注血療法後の結果の改善に不可欠です.

研究の目的:

急性不全性脳卒中でEVTを受ける患者の集中血圧管理と従来の血圧管理の有効性を比較する.
EVT後の24時間以内に機能的独立性および安全性に関するBP目標の影響を評価する.

主な方法:

EVTで治療された大血管閉塞性急性不全性脳卒中の患者306人を対象とした多センターランダム化オープン試験.
参加者は24時間集中血圧管理 (シストリック血圧<140mmHg) または従来の血圧管理 (シストリック血圧140~180mmHg) に割り当てられました.
ランキンスケール (Rankin Scale) で評価された3ヶ月後の機能的独立性でした.

主要な成果:

試験は安全性上の懸念のために早期に終了されました. 3ヶ月の集中治療は,従来の治療 (54. 4%) に比べて機能的独立率の低下と関連していました.
症状のある脳内出血の頻度 (9. 0% 対 8. 1%) は有意な差異は見られなかった.
3ヶ月以内にインデックス脳卒中に関連した死亡率は,従来のグループ (5. 4%) よりも集中治療群 (7. 7%) で高かった.

結論:

大血管閉塞による急性性血栓性脳卒中のEVTが成功した後での集中的なBP管理は,3ヶ月後に機能的アウトカムと関連しています.
これらの発見は,この患者集団において,高血圧管理を避けるべきであることを示唆しています.
従来のBP管理はEVT後のより安全で効果的な戦略であるようです.

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