Faculty of Medicine, Tanta University, Tanta, Egypt.
Faculty of Medicine, University of Algiers, Algiers, Algeria.
Clin Neuroradiol. 2024 Sep;34(3):563-575. doi: 10.1007/s00062-024-01391-6. Epub 2024 Mar 7.
Optimal clinical outcome with successful recanalization from endovascular thrombectomy (EVT) requires optimal blood pressure (BP) management. We aimed to evaluate the efficacy and safety of the intensive BP target (< 140 mm Hg) versus the standard BP target (< 180 mm Hg) after EVT for acute ischemic stroke.
We conducted a systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) obtained from PubMed, Embase Cochrane, Scopus, and WOS until September 7th, 2023. We used the fixed-effect model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI).
CRD42023463206.
We included four RCTs with 1559 patients. There was no difference between intensive BP and standard BP targets regarding the National Institutes of Health Stroke Scale (NIHSS) change after 24 h [MD: 0.44 with 95% CI (0.0, 0.87), P = 0.05]. However, the intensive BP target was significantly associated with a decreased risk of excellent neurological recovery (mRS ≤ 1) [RR: 0.87 with 95% CI (0.76, 0.99), P = 0.03], functional independence (mRS ≤ 2) [RR: 0.81 with 95% CI (0.73, 0.90), P = 0.0001] and independent ambulation (mRS ≤ 3) [RR: 0.85 with 95% CI (0.79, 0.92), P < 0.0001].
An intensive BP target after EVT is associated with worse neurological recovery and significantly decreased rates of functional independence and independent ambulation compared to the standard BP target. Therefore, the intensive BP target should be avoided after EVT for acute ischemic stroke.
血管内血栓切除术（EVT）成功再通后，最佳临床结局需要最佳血压（BP）管理。我们旨在评估 EVT 后强化 BP 目标（<140mmHg）与标准 BP 目标（<180mmHg）对急性缺血性脑卒中的疗效和安全性。
我们进行了一项系统评价和荟萃分析，综合了从PubMed、Embase Cochrane、Scopus 和 WOS 获得的随机对照试验（RCT）的证据，截至 2023 年 9 月 7 日。我们使用固定效应模型报告二分类结局的风险比（RR）和连续结局的均数差（MD），置信区间（CI）为 95%。
CRD42023463206。
我们纳入了四项 RCTs，共 1559 例患者。强化 BP 与标准 BP 目标在 24 小时后 NIHSS 变化方面无差异[MD：0.44，95%CI（0.0，0.87），P=0.05]。然而，强化 BP 目标与神经功能良好恢复（mRS≤1）的风险降低显著相关[RR：0.87，95%CI（0.76，0.99），P=0.03]，功能独立性（mRS≤2）[RR：0.81，95%CI（0.73，0.90），P=0.0001]和独立行走（mRS≤3）[RR：0.85，95%CI（0.79，0.92），P<0.0001]。
与标准 BP 目标相比，EVT 后强化 BP 目标与较差的神经恢复相关，并且功能独立性和独立行走的比例显著降低。因此，EVT 后急性缺血性脑卒中应避免强化 BP 目标。
