Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke and Blood Pressure Management After Endovascular Therapy for Acute Ischemic Stroke
Published on: October 19, 2023
Two new studies focus on blood pressure (BP) management after endovascular therapy for acute ischemic stroke. In the OPTIMAL-BP randomized clinical trial, researchers compared early intensive BP management with conventional BP management in the first 24 hours after successful reperfusion. The study included 306 patients with large vessel occlusion acute ischemic stroke treated with endovascular thrombectomy and with a modified Thrombolysis in Cerebral Infarction score of 2b or greater (partial or complete reperfusion). Patients were randomized to receive intensive BP management, aiming for a systolic BP target <140 mm Hg (N=155), or conventional management, aiming for a systolic BP target of 140-180 mm Hg (N=150) for 24 hours. The primary outcome – functional independence, as measured by a modified Rankin Scale (mRS) score of ≤2, at 3 months – was achieved by 39.4% of the patients in the intensive BP management group and 54.4% of those in the conventional management group, a significant difference. The trial was stopped early following safety concerns by the independent data and safety monitoring board. In the second study, the BEST-II trial, researchers examined the futility of moderately lowering systolic BP in patients with acute ischemic stroke after undergoing successful endovascular therapy. After receiving endovascular therapy, 120 patients were randomized to one of three systolic BP target groups: 40 to <140 mm Hg, 40 to <160 mm Hg, and 40 to 180 mm Hg or less (guideline recommended group). Treatment started within 60 minutes of recanalization and continued for 24 hours. Prespecified primary outcomes for the primary futility analysis included follow-up infarct volume measured at 36 hours and utility-weighted mRS score at 90 days. According to the data, systolic BP targets of less than 140 mm Hg or 160 mm Hg after successful endovascular therapy did not meet did not meet prespecified criteria for futility compared with the guideline-recommended target of 180 mm Hg or less. Using the utility-weighted mRS score, there was a low likelihood of benefit in a future superiority trial comparing systolic lower blood pressure targets after endovascular therapy to the guideline-recommended target.
Intensive vs Conventional Blood Pressure Lowering After Endovascular Thrombectomy in Acute Ischemic Stroke
Journal of the American Medical Association(09/05/23) DOI: 10.1001/jama.2023.14590
Nam, Hyo Suk; Kim, Young Dae; Heo, JoonNyung; et al.
Blood Pressure Management After Endovascular Therapy for Acute Ischemic Stroke
Journal of the American Medical Association(09/05/23) DOI: 10.1001/jama.2023.14330
Mistry, Eva A.; Hart, Kimberly W.; Davis, Larry T.; et al.