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Optimal Blood Pressure Control After Endovascular Thrombectomy for Acute Ischemic Stroke

In adults who have received endovascular thrombectomy for acute ischemic stroke due to intracranial large-vessel occlusion, intensive blood pressure control to systolic pressures of less than 120 mm Hg should be avoided, according to results of the ENCHANTED2/MT trial. Pushing treatments to achieve lower systolic blood pressure can compromise the functional recovery of patients, the investigators conclude.

The trial was conducted at 44 tertiary-level hospitals in China. Participants were 821 adults with persistently elevated systolic blood pressure of 140 mm Hg or more for more than 10 minutes after successful reperfusion with endovascular thrombectomy for acute ischemic stroke from any intracranial large-vessel occlusion. Participants were randomized to more or less intensive treatment (systolic blood pressure of <120 mm Hg or 140–180 mm Hg, respectively) to be achieved within 1 hour and sustained for 72 hours. The primary efficacy outcome was functional recovery as assessed at 90 days on the modified Rankin scale.

When the trial was stopped because of efficacy and safety concerns, results were as follows: “The likelihood of poor functional outcome was greater in the more intensive treatment group than the less intensive treatment group (common OR 1.37 [95% CI 1.07–1.76]). Compared with the less intensive treatment group, the more intensive treatment group had more early neurological deterioration (common OR 1.53 [95% 1.18–1.97]) and major disability at 90 days (OR 2.07 [95% CI 1.47–2.93]), but there were no significant differences in symptomatic intracerebral haemorrhage. There were no significant differences in serious adverse events or mortality between groups.”

Source: Lancet