School of Nursing, Zhejiang Chinese Medical University, Hangzhou City, Zhejiang Province, China.
Department of Emergency Medcine, the Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou City, China.
Clin Neurol Neurosurg. 2023 Aug;231:107835. doi: 10.1016/j.clineuro.2023.107835. Epub 2023 Jun 14.
The objective of this meta-analysis was to explore the impact of different blood pressure levels following endovascular therapy on clinical outcomes, including safety and efficacy in acute ischemic stroke (AIS) patients.
A systematic search was performed on PubMed, Embase, Cochrane Library, and Web of Science databases, covering studies published before February 1, 2023. Our primary outcomes were 90-day mRs 0-2 score, 90-day mortality, incidence of symptomatic intracranial hemorrhage(sICH), and hemicraniectomy.
The incidence of 90-day mRs= 2 score was no significant difference between different blood pressure values (OR=1.37, 95 % CI [0.82, 2.29], p = 0.23) with heterogeneity (I =85 %, p < 0.001). Subgroup analysis indicated that when the blood pressure targets were SBP< 140 mmHg (OR=1.73, 95 % CI [1.04, 2.90], p = 0.04) with heterogeneity (I =37 %, p = 0.20), and SBP< 130 mmHg (OR=1.58, 95 % CI [0.53, 4.70], p = 0.41) with heterogeneity (I =80 %, p = 0.02), there were statistic differences in the incidence of 90-day modified mRs 0-2 score. Regarding 90-day mortality, there was no significant difference between different blood pressure values (OR=0.75, 95 % CI [0.47, 1.21], p = 0.24; I =69 %, p = 0.007). As for the incidence of sICH, the difference was not statistically significant (OR = 0.82, 95 % CI [0.61, 1.09], p = 0.17; I =24 %, p = 0.26). However, subgroup analysis was performed due to different blood pressure values, and it was found that when the blood pressure targets were SBP＜140 mmHg (OR=0.49, 95 % CI [0.28, 0.87], p = 0.02) and SBP＜120 mmHg (OR = 0.84, 95 % CI [0.58, 1.23], p = 0.37), there were statistic differences in the incidence of sICH with SBP＜140 mmHg. Furthermore, SBP＜140 mmHg was associated with a lower incidence of hemicraniectomy (OR = 0.30, 95 % CI [0.15, 0.58], p＜0.001). PROSPERO Register Number: CRD42022376706 CONCLUSION: The present meta-analysis findings indicate that intensive treatment is advantageous for achieving successful reperfusion in acute ischemic stroke (AIS) patients undergoing endovascular therapy (EVT). For different blood pressure targets (SBP < 140mmhg, SBP < 130mmhg, SBP < 120mmhg), with a reduction in systolic blood pressure (SBP) to less than 140 mmHg appearing to confer the greatest benefit. Furthermore, this study provides a significant blood pressure target that could inform the design of future multicentre, open-label, blinded-endpoint, randomized controlled trials.
本荟萃分析旨在探讨血管内治疗后不同血压水平对急性缺血性脑卒中（AIS）患者临床结局的影响，包括安全性和疗效。
系统检索 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库，纳入截至 2023 年 2 月 1 日前发表的研究。我们的主要结局是 90 天 mRs 0-2 评分、90 天死亡率、症状性颅内出血（sICH）发生率和去骨瓣减压术。
不同血压值之间 90 天 mRs=2 评分的发生率无显著差异（OR=1.37，95%CI[0.82，2.29]，p=0.23），存在异质性（I=85%，p<0.001）。亚组分析表明，当血压目标为 SBP<140mmHg（OR=1.73，95%CI[1.04，2.90]，p=0.04）时存在异质性（I=37%，p=0.20），且 SBP<130mmHg（OR=1.58，95%CI[0.53，4.70]，p=0.41）时存在异质性（I=80%，p=0.02），90 天改良 mRs 0-2 评分的发生率存在统计学差异。关于 90 天死亡率，不同血压值之间无显著差异（OR=0.75，95%CI[0.47，1.21]，p=0.24；I=69%，p=0.007）。至于 sICH 的发生率，差异无统计学意义（OR=0.82，95%CI[0.61，1.09]，p=0.17；I=24%，p=0.26）。然而，由于不同的血压值进行了亚组分析，发现当血压目标为 SBP<140mmHg（OR=0.49，95%CI[0.28，0.87]，p=0.02）和 SBP<120mmHg（OR=0.84，95%CI[0.58，1.23]，p=0.37）时，sICH 的发生率存在统计学差异。此外，SBP<140mmHg 与去骨瓣减压术发生率降低相关（OR=0.30，95%CI[0.15，0.58]，p<0.001）。PROSPERO 注册号：CRD42022376706。
本荟萃分析结果表明，强化治疗有利于接受血管内治疗（EVT）的急性缺血性脑卒中（AIS）患者实现成功再灌注。对于不同的血压目标（SBP<140mmHg，SBP<130mmHg，SBP<120mmHg），降低收缩压（SBP）至 140mmHg 以下似乎带来最大益处。此外，本研究提供了一个重要的血压目标，可为未来的多中心、开放标签、盲终点、随机对照试验设计提供信息。
