Liu Yifeng, Zhu Xuan, Zhang Donghuan, Li Zhaoshuo, Zhang Gaoqi, Zheng Haocun, Lan Duanyun, Qin Hao, Shen Hongjian, Xing Pengfei, Yang Pengfei, Zhang Lei, Zhang Yongwei, Zhang Xiaoxi, Ye Xiaofei, Wen Changming, Zhong Hailong, Liu Jianmin
Department of Neurology, Nanyang Central Hospital, Nanyang, Henan, China.
Neurovascular Center, Changhai Hospital, Shanghai, Shanghai, China.
J Neurointerv Surg. 2025 Jul 15. doi: 10.1136/jnis-2025-023697.
The optimal threshold or range for systolic blood pressure (SBP) control in patients with successful reperfusion after endovascular thrombectomy for acute ischemic stroke (AIS) remains undefined. This study investigated whether SBP within the first 24 hours after successful reperfusion correlates with functional outcomes in AIS.
In this secondary analysis of the ENCHANTED2/MT trial, patients were categorized into two groups (120-140 mm Hg and 140-180 mm Hg, respectively) based on achieved SBP within 24 hours after randomization. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included neurological deterioration at 7 days, major disability (mRS score of 3-5 at 90 days), hospitalization duration, and health-related quality of life assessed by the three-level EuroQoL 5-Dimension Self-Report Questionnaire (EQ-5D-3L) at 90 days. Safety outcomes included early neurological decline (END), 90-day mortality, symptomatic intracranial hemorrhage (sICH), and any intracranial hemorrhage (ICH). Treatment effects were expressed as ORs with 95% confidence intervals (CIs).
A total of 611 patients (363 in the 120-140 mm Hg group and 248 in the 140-180 mm Hg group) were included. The mean (SD) age was 67 (12) years and 37.8% were female. After adjusting for confounders, the 120-140 mm Hg group was significantly associated with better functional outcomes (mRS: 2 (IQR 1-4) vs 2 (IQR 1-5); adjusted OR 1.54 (95% CI 1.10 to 2.17), P=0.013). Compared with the 140-180 mm Hg group, the 120-140 mm Hg group had lower rates of neurological deterioration at 7 days (adjusted OR 0.68 (95% CI 0.47 to 0.98), P=0.037) and 90-day mortality (47 (13.0%) vs 53 (21.4%); adjusted OR 0.48 (95% CI 0.27 to 0.86), P=0.013). There were no significant differences between groups in END, major disability at 90 days, hospitalization duration, EQ-5D-3L score, sICH, or ICH (all P>0.05).
In patients with successful reperfusion after endovascular thrombectomy, an average SBP within 24 hours of 120-140 mm Hg was associated with a greater likelihood of functional independence compared with 140-180 mm Hg.
急性缺血性卒中（AIS）血管内血栓切除术后成功再灌注患者的收缩压（SBP）控制的最佳阈值或范围仍未明确。本研究调查了成功再灌注后24小时内的SBP是否与AIS患者的功能结局相关。
在ENCHANTED2/MT试验的这项二次分析中，根据随机分组后24小时内达到的SBP，将患者分为两组（分别为120 - 140 mmHg和140 - 180 mmHg）。主要结局是90天时的改良Rankin量表（mRS）评分。次要结局包括7天时的神经功能恶化、严重残疾（90天时mRS评分为3 - 5）、住院时间，以及90天时通过三级欧洲五维健康量表自我报告问卷（EQ - 5D - 3L）评估的健康相关生活质量。安全性结局包括早期神经功能减退（END）、90天死亡率、症状性颅内出血（sICH）和任何颅内出血（ICH）。治疗效果以比值比（OR）及其95%置信区间（CI）表示。
共纳入611例患者（120 - 140 mmHg组363例，140 - 180 mmHg组248例）。平均（标准差）年龄为67（12）岁，女性占37.8%。在调整混杂因素后，120 - 140 mmHg组与更好的功能结局显著相关（mRS：2（四分位间距1 - 4）对2（四分位间距1 - 5）；调整后OR 1.54（95%CI 1.10至2.17），P = 0.013）。与140 - 180 mmHg组相比，120 - 140 mmHg组7天时神经功能恶化的发生率较低（调整后OR 0.68（95%CI 0.47至0.98），P = 0.037），90天死亡率也较低（47例（13.0%）对53例（21.4%）；调整后OR 0.48（95%CI 0.27至0.86），P = 0.013）。两组在END、90天时的严重残疾、住院时间、EQ - 5D - 3L评分、sICH或ICH方面均无显著差异（所有P>0.05）。
在血管内血栓切除术后成功再灌注的患者中，与140 - 180 mmHg相比，24小时内平均SBP为120 - 140 mmHg与功能独立的可能性更大相关。
