Department of Anaesthesia and Peri-operative Medicine, Auckland City Hospital, Auckland, New Zealand.
Department of Radiology, Auckland City Hospital, Auckland, New Zealand.
Anaesthesia. 2020 Jun;75(6):739-746. doi: 10.1111/anae.14940. Epub 2019 Dec 12.
It is unknown whether systolic blood pressure augmentation during endovascular thrombectomy improves clinical outcomes. This pilot randomised controlled trial aimed to assess the feasibility of differential systolic blood pressure targeting during endovascular thrombectomy procedures for anterior circulation ischaemic stroke. Fifty-one eligible patients fulfilling the national criteria for endovascular thrombectomy were randomly assigned to receive either standard or augmented systolic blood pressure management from the start of anaesthesia to recanalisation of the target vessel. Systolic blood pressure targets for the standard and augmented groups were 130-150 mmHg and 160-180 mmHg, respectively. The study achieved all feasibility targets, including a recruitment rate of 3.5 participants per week and median (IQR [range]) of mean systolic blood pressure separation between groups of 139 (135-143 [115-154]) vs. 167 (150-175 [113-188]) mmHg, p < 0.001. Data completeness was 99%. Independent functional recovery at 90 days (modified Rankin Scale 0, 1 or 2) was achieved in 30 (59%) patients, which is consistent with previously published data. There were no safety concerns with trial procedures. In conclusion, a large randomised controlled efficacy trial of standard vs. augmented systolic blood pressure management during endovascular thrombectomy is feasible.
目前尚不清楚血管内血栓切除术期间收缩压升高是否能改善临床结局。这项先导随机对照试验旨在评估在前循环缺血性卒中血管内血栓切除术过程中针对收缩压进行差异目标管理的可行性。符合血管内血栓切除术国家标准的 51 名合格患者被随机分配接受标准或增强的收缩压管理，从麻醉开始到目标血管再通。标准组和增强组的收缩压目标分别为 130-150mmHg 和 160-180mmHg。该研究达到了所有可行性目标，包括每周招募 3.5 名参与者的招募率中位数（IQR[范围]）为组间平均收缩压分离 139（135-143[115-154]）与 167（150-175[113-188]）mmHg，p<0.001。数据完整性为 99%。90 天（改良 Rankin 量表 0、1 或 2）时独立功能恢复的患者有 30 例（59%），这与先前发表的数据一致。试验程序没有安全问题。总之，在血管内血栓切除术期间进行标准与增强收缩压管理的大型随机对照疗效试验是可行的。
