Impact of intensive blood pressure lowering after multiple-attempt endovascular thrombectomy: A secondary analysis of the OPTIMAL-BP trial.

Autor:	Jung JW; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Kim KH; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Yun J; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Kim YD; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Heo J; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Lee H; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Choi JK; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Lee H Il; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Lim IH; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Hong SH; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Kim BM; Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea., Kim DJ; Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea., Shin NY; Department of Radiology, Yonsei University College of Medicine, Seoul, South Korea., Cho BH; Department of Neurology, Korea University Anam Hospital and College of Medicine, Seoul, South Korea., Ahn SH; Department of Neurology, Chosun University School of Medicine, Gwangju, South Korea., Park H; Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea., Sohn SI; Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea., Hong JH; Department of Neurology, Brain Research Institute, Keimyung University School of Medicine, Daegu, South Korea., Song TJ; Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea., Chang Y; Department of Neurology, Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea., Kim GS; National Health Insurance Service Ilsan Hospital, Goyang, South Korea., Seo KD; National Health Insurance Service Ilsan Hospital, Goyang, South Korea., Lee K; National Health Insurance Service Ilsan Hospital, Goyang, South Korea., Chang JY; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Seo JH; Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea., Lee S; Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea., Baek JH; Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea., Cho HJ; Department of Neurology, Pusan National University School of Medicine, Busan, South Korea., Shin DH; Department of Neurology, Gachon University Gil Medical Center, Incheon, South Korea., Kim J; Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea., Yoo J; Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea., Baik M; Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea., Lee KY; Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea., Jung YH; Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea., Hwang YH; Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea., Kim CK; Department of Neurology, Korea University Guro Hospital and College of Medicine, Seoul, South Korea., Kim JG; Department of Neurology, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, South Korea., Lee CJ; Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea., Park S; Department of Health Promotion, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea., Jeon S; Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea., Lee HS; Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea., Kwon SU; Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea., Young Bang O; Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea., Heo JH; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea., Nam HS; Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Jazyk:	angličtina
Zdroj:	International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2024 Dec; Vol. 19 (10), pp. 1134-1146. Date of Electronic Publication: 2024 Aug 05.
DOI:	10.1177/17474930241265652
Abstrakt:	Background: Multiple attempts of thrombectomy have been linked to a higher risk of intracerebral hemorrhage and worsened functional outcomes, potentially influenced by blood pressure (BP) management strategies. Nonetheless, the impact of intensive BP management following successful recanalization through multiple attempts remains uncertain. Aims: This study aimed to investigate whether conventional and intensive BP managements differentially affect outcomes according to multiple-attempt recanalization (MAR) and first-attempt recanalization (FAR) groups. Methods: In this secondary analysis of the OPTIMAL-BP trial, which was a comparison of intensive (systolic BP target: <140 mm Hg) and conventional (systolic BP target = 140-180 mm Hg) BP managements during the 24 h after successful recanalization, we included intention-to-treat population of the trial. Patients were divided into the MAR and the FAR groups. We examined a potential interaction between the number of thrombectomy attempts (MAR and FAR groups) and the effect of BP managements on clinical and safety outcomes. The primary outcome was functional independence at 3 months. Safety outcomes were symptomatic intracerebral hemorrhage within 36 h and mortality within 3 months. Results: Of the 305 patients (median = 75 years), 102 (33.4%) were in the MAR group and 203 (66.6%) were in the FAR group. The intensive BP management was significantly associated with a lower rate of functional independence in the MAR group (intensive, 32.7% vs conventional, 54.9%, adjusted odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.12-0.90, p  = 0.03). In the FAR group, the proportion of patients with functional independence was not significantly different between the BP managements (intensive, 42.5% vs conventional, 54.2%, adjusted OR = 0.73, 95% CI = 0.38-1.40). Incidences of symptomatic intracerebral hemorrhage and mortality rates were not significantly different according to the BP managements in both MAR and FAR groups. Conclusions: Among stroke patients who received multiple attempts of thrombectomy, intensive BP management for 24 h resulted in a reduced chance of functional independence at 3 months and did not reduce symptomatic intracerebral hemorrhage following successful reperfusion. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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