Blood pressure targets after successful reperfusion in mechanical thrombectomy for acute ischemic stroke: an updated systematic review and meta-analysis of randomized clinical trials

被引:1
作者
Neto, Edgar Paulo da Silva [1 ]
Ferreira, Lucas Fernandes [2 ]
Hernandez, Ana Luisa Carvalho de Cardozo [2 ]
Figueiredo, Eberval Gadelha [3 ]
Telles, Joao Paulo Mota [2 ]
机构
[1] Hosp Geral Areias, Emergency Dept, Recife, Brazil
[2] Hosp Clin Univ Sao Paulo, Dept Neurol, Sao Paulo, Brazil
[3] Hosp Clin Univ Sao Paulo, Div Neurosurg, Sao Paulo, Brazil
关键词
Ischemic stroke; Thrombectomy; Reperfusion; Blood pressure; ENDOVASCULAR THROMBECTOMY; MANAGEMENT; EFFICACY; THERAPY;
D O I
10.1007/s10072-024-07458-z
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background This study sought to determine whether intensive blood pressure (BP) control for patients with successful reperfusion following acute ischemic stroke (AIS) is beneficial, compared to conventional BP management. Methods PubMed, Embase, and Cochrane databases were systematically searched for randomized controlled trials (RCTs) on the subject. The studied outcomes included dependency or death at 90 days (modified Rankin Scale [mRS] 3-6); severe disability at 90 days (mRS 3-5); mortality at 90 days; and symptomatic intracranial hemorrhage. Odds ratios (OR) with 95% confidence intervals were used to compare the treatment effects for categorical outcomes. We employed a fixed-effect model for analyses with low heterogeneity (I-2 < 25%) and a random-effects model for analyses with higher heterogeneity. Results A total of 1519 patients were included, with 50% (n = 760) receiving intensive BP control (systolic BP < 140 mmHg). Functional disability or death at 90 days was significantly higher in the intensive group (54.9%) compared to the conventional treatment group (44.1%) (OR = 1.51; 95% Confidence Interval [CI]: 1.15-1.96; p = 0.003; I-2 = 29%). Severe functional disability (mRS 3-5) was significantly higher in the intensive group (30.6% vs. 43.5%, OR = 1.75; 95%CI = 1.36-2.25; p < 0.0001; I-2 = 0%). There was no difference in symptomatic intracranial hemorrhage (OR = 1.13; 95%CI = 0.76-1.67) or mortality (OR = 1.22; 95%CI = 0.9-1.64). Conclusions Intensive BP control is harmful in patients who underwent EVT for AIS and achieved successful reperfusion. It yields higher rates of functional dependence, with no differences in mortality or symptomatic intracranial hemorrhage.
引用
收藏
页码:3879 / 3886
页数:8
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