Intensive versus less intensive blood pressure targets after mechanical thrombectomy in acute ischemic stroke: a systematic review and network meta-analysis.

Autor: de Oliveira BFS; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil. bruno.oliveiraphysci@gmail.com., Bispo RG; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil., Dos Santos BHRA; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil., Pereira LFV; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil., Assis GE; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil., Abbade PF; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil., Cazé AB; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil., Neves BM; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil., Oliveira-Filho J; Faculty of Medicine of Bahia, Federal University of Bahia, Bahia, Brazil.
Jazyk: angličtina
Zdroj: Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [Neurol Sci] 2024 Jun 17. Date of Electronic Publication: 2024 Jun 17.
DOI: 10.1007/s10072-024-07647-w
Abstrakt: Hemodynamic management, specifically blood pressure, is essential to reduce mortality and preserve functional capacity. However, the literature is uncertain about the best blood pressure target to be adopted after performing mechanical thrombectomy in patients with acute ischemic stroke. Randomized clinical trials that compared blood pressure goals after mechanical thrombectomy were searched in the following databases: MEDLINE/PubMed, Embase, Scopus, Biomedcentral, and Cochrane Library. The last search was on September 19, 2023. The results obtained were used to construct network meta-analyses. A total of 1556 participants were enrolled from 4 randomized controlled trials (OPTIMAL-BP, ENCHANTED2/MT, BP-TARGET, BEST-II). The last article was not included in the network meta-analysis because it did not have common blood pressure targets. The outcomes compared were: mRS (modified Rankin scale), eTICI/mTICI scale scores, symptomatic and any intracerebral hemorrhage, post-intervention NIHSS, and post-intervention infarct volume. The outcomes using the mRS scale showed that better outcomes were reached with less intensive blood pressure targets when comparing < 120 mmHg vs. ≤ 180 mmHg, OR: 0.71 (95% CI 0.54 - 0.94), in the outcome of mRS 0-1. And for the mRS 0-2 outcome with comparisons < 120 mmHg vs. ≤ 180 mmHg, with OR: 0.59 (95% CI 0.44 - 0.77) and < 140 mmHg vs. ≤ 180 mmHg, with OR: 0.61 (95% CI 0.41 - 0.89). In patients with large vessel occlusion treated with mechanical thrombectomy and who achieved good reperfusion, intensive blood pressure lowering is not effective and might be harmful respect to non intensive blood pressure control in recanalized patients.
(© 2024. Fondazione Società Italiana di Neurologia.)
Databáze: MEDLINE
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