Intensive BP Control Harmful After Endovascular Thrombectomy for Acute Ischemic Stroke

An open-label, blinded-endpoint, randomized controlled trial in China suggested that intensive control of systolic blood pressure (SBP) to lower than 120 mm Hg should be avoided to prevent compromising the functional recovery of patients who have received endovascular thrombectomy due to intracranial large-vessel occlusion. The trial enrolled 821 patients (aged ≥18 years who had persistently SBP≥140 mm Hg for >10 min post successful reperfusion with endovascular thrombectomy) from July 20, 2020 to March 7, 2022 and was stopped after review of the outcome data on June 22, 2022, due to persistent efficacy and safety concerns. Patients were randomly assigned to more intensive (SBP target <120 mm Hg) or less intensive (target 140–180 mm Hg) treatment to be achieved within 1 h and sustained for 72 h. There were 404 and 406 patients, respectively in the more and less intensive treatment groups with primary outcome data (functional recovery, assessed according to the distribution in scores on the modified Rankin scale at 90 days). On the modified intention-to-treat analysis, the likelihood of poor functional outcome was greater in the more intensive treatment group than the less intensive treatment group (common OR 1·37). Compared with the less intensive treatment group, the more intensive treatment group had more early neurological deterioration (common OR 1·53) and major disability at 90 days (OR 2·07). There were no significant differences in serious adverse events including symptomatic intracerebral hemorrhage or mortality between groups. Considering the results of previous trials, which assessed the effects of intensive BP lowering after thrombolysis treatment in patients receiving endovascular treatment and in a broad range of patients, respectively, with acute ischemic stroke, the results suggest that the benefit of BP lowering in reducing the risk of reperfusion-related intracranial hemorrhage might not extend beyond a certain SBP target of less than 140 mm Hg. Source: https://www.thelancet.com/