Blood pressure management after endovascular thrombectomy: Insights of recent randomized controlled trials

• Published in: CNS neuroscience & therapeutics Vol. 30; no. 8; pp. e14907 - n/a
• Main Authors: Dong, Xiao, Liu, Yuanyuan, Chu, Xuehong, Yu, Erlan, Jia, Xiaole, Ji, Xunming, Wu, Chuanjie
• Format: Journal Article
• Language: English
• Published: Oxford John Wiley & Sons, Inc 01.08.2024
• Subjects: acute ischemic stroke; Blood flow; Blood pressure; Cardiovascular system; Cerebral blood flow; Clinical trials; endovascular thrombectomy; Hemorrhage; Ischemia; Management; Observational studies; Patients; randomized controlled trials; Reperfusion; Stroke
• ISSN: 1755-5930; 1755-5949; 1755-5949
• DOI: 10.1111/cns.14907

Background The ideal blood pressure (BP) target in patients who undergo endovascular thrombectomy (EVT) with successful reperfusion is uncertain. Observational studies show that elevated BP during this period is associated with a higher risk of intracranial hemorrhage (ICH) and worse clinical outcomes. Several randomized controlled trials (RCTs) have explored whether intensive BP lowering improves clinical outcomes in these patients. Aims This review aims to summarize the recent RCTs that compare intensive and conventional BP management strategies following EVT and discuss the innovative directions to improve. Result The recently published RCTs failed to demonstrate the benefit of intensive BP control on the functional outcome and decreasing the risk of ICH. The complex mechanism in cerebral blood flow regulation and the inappropriate BP range chosen in RCTs may be the reasons behind the inconsistent results between observational studies and RCTs. Individualized BP management, reducing BP variability, and multi‐stage BP management should be paid more attention in future exploration. Conclusion Intensive BP target did not improve clinical outcomes after successful EVT as compared with a conventional BP target. Further research is required to identify the optimal BP management strategy after reperfusion. The ideal systolic blood pressure target following successful endovascular thrombectomy remains unclear. This article summarizes and analyzes the key conclusions and implications of recent randomized controlled trials, while also exploring the innovative directions for optimizing blood pressure control following endovascular thrombectomy. The recently completed randomized controlled trials failed to demonstrate the beneficial effect of intensive blood pressure control on both the functional outcome and reduction of the risk of intraparenchymal hemorrhage. Future research should place greater emphasis on individualized blood pressure management strategies, minimizing blood pressure variability, and implementing multi‐stage BP management protocols in this field.