Yun Jaeseob, Kim Kwang Hyun, Jung Jae Wook, Kim Young Dae, Heo JoonNyung, Lee Hyungwoo, Choi Jin Kyo, Lim In Hwan, Hong Soon-Ho, Kim Byung Moon, Kim Dong Joon, Shin Na Young, Cho Bang-Hoon, Ahn Seong Hwan, Park Hyungjong, Sohn Sung-Il, Hong Jeong-Ho, Song Tae-Jin, Chang Yoonkyung, Kim Gyu Sik, Seo Kwon-Duk, Lee Kijeong, Chang Jun Young, Seo Jung Hwa, Lee Sukyoon, Baek Jang-Hyun, Cho Han-Jin, Shin Dong Hoon, Kim Jinkwon, Yoo Joonsang, Baik Minyoul, Lee Kyung-Yul, Jung Yo Han, Hwang Yang-Ha, Kim Chi Kyung, Kim Jae Guk, Lee Chan Joo, Park Sungha, Jeon Soyoung, Lee Hye Sun, Kwon Sun U, Lee Il Hyung, Bang Oh Young, Heo Ji Hoe, Nam Hyo Suk
Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiology, Yonsei University College of Medicine, Seoul, Korea.
Int J Stroke. 2025 Feb 6:17474930251315630. doi: 10.1177/17474930251315630.
The effects of blood pressure (BP) lowering in patients treated with intravenous tissue plasminogen activator (IV tPA) before endovascular thrombectomy (EVT) are unclear.
This study aims to investigate whether intensive and conventional BP management affects outcomes differently, depending on IV tPA administration before EVT.
In this subgroup analysis of the Outcome in Patients Treated with Intra-Arterial Thrombectomy-Optimal Blood Pressure Control (OPTIMAL-BP; ClinicalTrials.gov Identifier: NCT04205305) trial, patients were divided into groups based on IV tPA use before EVT. Clinical outcomes of intensive (systolic BP target < 140 mm Hg) or conventional BP management (systolic BP target 140-180 mm Hg) were compared among groups. The primary efficacy outcome was a favorable outcome at 3 months (modified Rankin Scale score of 0-2). Primary safety outcomes included symptomatic intracerebral hemorrhage (sICH) within 36 h and stroke-related death within 3 months.
Among the 302 patients, the IV tPA group included 98 (32.5%) and the non-IV tPA group comprised 204 subjects (67.5%). In the IV tPA group, intensive BP management significantly lowered the favorable outcome rate (intensive, 27.3% vs. conventional, 51.9%; adjusted odds ratio [aOR], 0.36; 95% confidence interval [CI], 0.13-0.93; = 0.04). In the non-IV tPA group, the risk difference rate of favorable outcome was not significantly different between intensive and conventional BP management (44.1% vs. 55.9%; aOR, 0.62; 95% CI, 0.31-1.22; = 0.17). Notably, the proportion of malignant cerebral edema within 36 h in the IV tPA group was significantly higher in the intensive management group (18.2%) than in the conventional management group (1.9%; aOR, 10.72; 95% CI, 1.24-92.29; = 0.03). sICH and mortality rates were not significantly different between intensive and conventional BP management in either study groups.
Intensive BP management worsens 3-month functional outcomes after successful EVT without reducing sICH among patients who received IV tPA before EVT, indicating that BP lowering in this population should be cautious.
在血管内血栓切除术（EVT）前接受静脉注射组织型纤溶酶原激活剂（IV tPA）治疗的患者中，血压降低的效果尚不清楚。
本研究旨在调查强化和常规血压管理对结局的影响是否因EVT前是否使用IV tPA而有所不同。
在这项动脉内血栓切除术治疗患者的最佳血压控制（OPTIMAL-BP；ClinicalTrials.gov标识符：NCT04205305）试验的亚组分析中，根据EVT前是否使用IV tPA将患者分组。比较各组强化（收缩压目标<140 mmHg）或常规血压管理（收缩压目标140-180 mmHg）的临床结局。主要疗效结局是3个月时的良好结局（改良Rankin量表评分为0-2）。主要安全结局包括36小时内的症状性脑出血（sICH）和3个月内的卒中相关死亡。
在302例患者中，IV tPA组有98例（32.5%），非IV tPA组有204例（67.5%）。在IV tPA组中，强化血压管理显著降低了良好结局率（强化组为27.3%，常规组为51.9%；调整优势比[aOR]为0.36；95%置信区间[CI]为0.13-0.93；P=0.04）。在非IV tPA组中，强化和常规血压管理之间良好结局的风险差异率无显著差异（44.1%对55.9%；aOR为0.62；95%CI为0.31-1.22；P=0.17）。值得注意的是，IV tPA组中强化管理组36小时内恶性脑水肿的比例（18.2%）显著高于常规管理组（1.9%；aOR为10.72；95%CI为1.24-92.29；P=0.03）。在两个研究组中，强化和常规血压管理之间的sICH和死亡率均无显著差异。
在EVT前接受IV tPA治疗的患者中，强化血压管理会恶化成功EVT后3个月的功能结局，且未降低sICH，这表明该人群的血压降低应谨慎。
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