急性血栓性脳卒中における内血管療法後の血圧管理: BEST-II ランダム化臨床試験

Eva A Mistry¹, Kimberly W Hart², Larry T Davis³

¹Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio.

|September 5, 2023

まとめ

急性不全性脳卒中に対する血管内治療後の静脈血圧 (SBP) を < 140 mm Hg または < 160 mm Hg に下げるのは,無効性基準を満たさなかった. しかし,将来の試験では,これらの低いSBP目標から利益が得られる可能性は低い.

科学分野:

神経学
心臓病科
臨床試験

背景:

急性不全性脳卒中の内血管治療後の最適な静脈血圧 (SBP) 目標値は不明である.
以前の研究では,より低いSBP目標の有効性が決定的に確立されていません.

研究の目的:

急性不全性脳卒中の患者において,より高い目標値 (≤180 mm Hg) と比較して,より低いSBP値 (<140 mm Hgまたは<160 mm Hg) をターゲットにすることが無意味であるかを評価する.
心臓発作の容量と機能的な結果に対する SBP 目標の影響を評価する.

主な方法:

急性不全性脳卒中患者120人を対象とした,ランダム化,オープン,無効性臨床試験です.
患者は,エンド血管治療の24時間後に,SBP目標値<140mmHg,<160mmHg,または<180mmHgにランダムに分けられました.
主なアウトカムには,フォローアップの心臓発作量と,有用性による修正ランキンスケール (mRS) のスコアが含まれ,無益性について分析された.

主要な成果:

下のSBP目標値 (<140mmHgと<160mmHg) は,≤180mmHgの目標値と比較して,事前に指定された無益性基準を満たしていない.
平均心臓発作量は32. 4mL (< 140),50. 7mL (< 160) および46. 4mL (≤ 180) であった.
平均mRSスコアは0. 51 (< 140),0. 47 (< 160) および0. 58 (≤ 180) でした.
将来の試験の成功確率は低かった (<140mmHgでは25%,<160mmHgでは14%).

結論:

急性性不全性脳卒中の内血管治療が成功した後,SBPを< 140 mm Hgまたは< 160 mm Hgに低下させることは,無益であることが示されませんでした.
結果は,より大きな試験でこれらのより低いSBP目標を追求することで利益が得られる可能性が低いことを示唆しています.
この患者集団では,現在のガイドラインで推奨されているSBP目標値≤180mmHgは妥当と思われる.

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