Prognostic significance of early systolic blood pressure variability after endovascular thrombectomy and intravenous thrombolysis in acute ischemic stroke: A systematic review and meta-analysis

Objectives Previous studies have shown inconsistent results regarding the effect of early systolic blood pressure variability (SBPV) after endovascular thrombectomy (EVT) and intravenous thrombolysis (IVT) on functional outcome in acute ischemic stroke (AIS). Thesystematic review and meta-analysis aimed to determine the effect of early SBPV after EVT and IVT on outcome in AIS. Materials and Methods We searched for articles published before February 2020 in the following databases: PubMed, Web of Science, EMBASE, Medline, and Google Scholar. The pooled multivariate odds ratios (ORs) or relative risks (RRs) and 95% confidence intervals (CIs) were obtained using STATA 13.0 software. Results Increased early SBPV after EVT was significantly associated with worse functional outcome in AIS (OR = 1.42, 95% CI 1.02 to 1.99,I-2 = 82.4%,pvalue ofQtest < .001), whereas no significant associations were indicated between SBPV after IVT and functional outcome, symptomatic intracerebral hemorrhage (sICH) in AIS [functional outcome: RR = 1.08, 95% CI 0.96 to 1.22,I-2 = 0.0%,pvalue ofQtest = 0.793; sICH: RR = 2.40, 95% CI 0.71 to 8.03,I-2 = 78.2%,pvalue ofQtest = 0.01]. Conclusions The present study provided evidence that increased early SBPV after EVT is related to worse longer-term functional outcome in AIS, but the association is not significant in AIS patients treated with IVT. Furthermore, individualized BP management strategies were essential for AIS patients after EVT or IVT.