Panigrahi Baikuntha, Bhatia Rohit, Haldar Partha, Sarkar Risha, Longkumer Imnameren
Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
Department of Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Ann Indian Acad Neurol. 2025 May 1;28(3):323-332. doi: 10.4103/aian.aian_1087_24. Epub 2025 May 7.
The optimal systolic blood pressure (SBP) control after endovascular thrombectomy (EVT) is unclear. This study aimed to determine whether intensive SBP control (<140 mmHg) within 24 h post-EVT, compared to conventional management (<180 mmHg), leads to a better functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days.
Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched databases (PubMed, Scopus, EMBASE, Google Scholar, Web of Science) for English language articles up to March 15, 2024. We included randomized controlled trials (RCTs) and observational studies comparing intensive versus conventional SBP control up to 24 h post-EVT. Studies without separate primary outcome data and case series/reports were excluded. The primary outcome was functional independence (mRS 0-2 at 90 days).
Twelve studies (n = 5152 patients; five RCTs and seven observational studies) were included, and a primary analysis of the RCTs, along with a secondary exploratory analysis of the observational studies were conducted. The analysis of RCTs favored conventional control for the primary outcome (risk ratio [RR]- 0.81; 95% confidence interval [CI]- 0.73-0.90; P < 0.0001). Mortality rates (RR- 1.14, 95% CI- 0.89-1.45; P = 0.29) and the risk of symptomatic intracranial hemorrhage (RR- 1.10, 95% CI- 0.77-1.58; P = 0.60) were similar in both groups. The secondary exploratory analysis of observational data favored the intensive arm for the primary outcome (RR- 1.28, 95% CI- 1.17-1.41; P < 0.00001).
Our primary analysis of RCTs showed that intensive control was associated with poorer functional outcomes, with no significant impact on mortality rate or the risk of symptomatic intracranial hemorrhage. Although observational studies suggested better outcomes with intensive control, we recommend conventional management based on Level 1 evidence from RCTs.PROSPERO Registration no - CRD42023463173.
血管内血栓切除术（EVT）后最佳收缩压（SBP）控制尚不明确。本研究旨在确定与传统管理（收缩压<180 mmHg）相比，在EVT后24小时内进行强化SBP控制（收缩压<140 mmHg）是否能带来更好的功能结局，即90天时改良Rankin量表（mRS）评分为0 - 2分。
按照系统评价和Meta分析的首选报告项目指南，我们检索了截至2024年3月15日的数据库（PubMed、Scopus、EMBASE、谷歌学术、科学网），以查找英文文章。我们纳入了比较EVT后24小时内强化与传统SBP控制的随机对照试验（RCT）和观察性研究。排除没有单独主要结局数据的研究以及病例系列/报告。主要结局为功能独立性（90天时mRS为0 - 2）。
纳入了12项研究（n = 5152例患者；5项RCT和7项观察性研究），并对RCT进行了主要分析，同时对观察性研究进行了二次探索性分析。RCT分析显示，在主要结局方面，传统控制更具优势（风险比[RR] - 0.81；95%置信区间[CI] - 0.73 - 0.90；P < 0.0001）。两组的死亡率（RR - 1.14，95% CI - 0.89 - 1.45；P = 0.29）和症状性颅内出血风险（RR - 1.10，95% CI - 0.77 - 1.58；P = 0.60）相似。观察性数据的二次探索性分析显示，在主要结局方面强化组更具优势（RR - 1.28，95% CI - 1.17 - 1.41；P < 0.00001）。
我们对RCT的主要分析表明，强化控制与较差的功能结局相关，对死亡率或症状性颅内出血风险无显著影响。尽管观察性研究表明强化控制有更好的结局，但基于RCT的一级证据，我们建议采用传统管理。国际前瞻性系统评价注册编号 - CRD42023463173。
