Li Yunke, Zhao Yang, Zhang Xiaoxi, Sun Lingli, Wan Yingfeng, Zhang Yongwei, Yang Pengfei, Song Lili, Liu Jianmin, Anderson Craig S
The George Institute for Global Health China, Beijing, China,
The George Institute for Global Health China, Beijing, China.
Cerebrovasc Dis. 2025;54(1):138-144. doi: 10.1159/000537924. Epub 2024 Feb 20.
Although guidelines recommend a target blood pressure 185-180/105-110 mm Hg after mechanical thrombectomy for acute ischemic stroke, there is limited randomized evidence to support this level. We surveyed candidate institutions about the approach to blood pressure management in this patient group in preparation for inviting them to participate in the Enhanced Blood Pressure Control after Endovascular Thrombectomy for the Acute Ischemic Stroke Trial (ENCHANTED2/MT).
Physicians from a professional network of institutions that met mechanical thrombectomy qualification requirements were invited to participate in an online questionnaire covering basic clinical information as well as questions on blood pressure management.
We invited 88 sites to participate with 44 (50%) ultimately joining the trial, and a total of 88 physicians finished the survey. The median number of annual mechanical thrombectomy cases performed per site was 89 (IQR: 65-150). Only 38 (43%) institutions strictly adhere to guidelines when managing the blood pressure of mechanical thrombectomy patients. The most popular blood pressure target for reperfusion patients was 140-160 mm Hg (n = 47, 53%) and <120 mm Hg (n = 28, 32%). Fewer hospital stroke beds (40 [21-57] vs. 60 [39-110], p = 0.01) and lower proportion of elevated blood pressure after mechanical thrombectomy (25% [10-50%] vs. 50% [20-70%], p = 0.02) were related to a more aggressive blood pressure target (<120 mm Hg). Urapidil (n = 82, 93%) and calcium channel blockers (n = 87, 99%) were the most widely used antihypertensive drugs, respectively.
According to the survey, unstandardized blood pressure management protocols are performed in mechanical thrombectomy patients at institutions across China, which is different from prior survey from another country. More high-quality studies are needed to guide clinical practice.
尽管指南推荐急性缺血性卒中机械取栓术后的血压目标为185 - 180/105 - 110 mmHg，但支持该血压水平的随机证据有限。我们就该患者群体的血压管理方法对候选机构进行了调查，为邀请它们参与急性缺血性卒中血管内血栓切除术后强化血压控制试验（ENCHANTED2/MT）做准备。
邀请符合机械取栓资格要求的专业机构网络中的医生参与一份涵盖基本临床信息以及血压管理问题的在线问卷。
我们邀请了88个站点参与，最终44个（50%）站点加入了试验，共有88位医生完成了调查。每个站点每年进行机械取栓病例的中位数为89例（四分位间距：65 - 150）。在管理机械取栓患者的血压时，只有38个（43%）机构严格遵循指南。再灌注患者最常用的血压目标是140 - 160 mmHg（n = 47，53%）和<120 mmHg（n = 28，32%）。较少的医院卒中床位（40 [21 - 57] 对 60 [39 - 110]，p = 0.01）以及机械取栓术后血压升高比例较低（25% [10 - 50%] 对 50% [20 - 70%]，p = 0.02）与更积极的血压目标（<120 mmHg）相关。分别有82个（93%）和87个（99%）机构最常使用乌拉地尔和钙通道阻滞剂作为降压药物。
根据调查，中国各地机构对机械取栓患者的血压管理方案不规范，这与另一个国家之前的调查结果不同。需要更多高质量研究来指导临床实践。
