Impact of Blood Pressure After Successful Endovascular Therapy for Anterior Acute Ischemic Stroke: A Systematic Review

Abstract

Background and Purpose: Optimal blood pressure (BP) targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) still need to be assessed, especially according to the recanalization status. Facing the lack of randomized controlled trials addressing this question, we performed a systematic review of studies assessing the post-EVT BP impact on functional outcome and symptomatic intracranial hemorrhage (sICH). Methods: Studies published after January 1, 2012 were included in the systematic review. The PRISMA checklist and flow diagram were followed for the design and reporting of this work. Results: Five studies were included in the present analysis. Despite a significant heterogeneity among studies which precluded a meta-analysis, systolic BP (SBP) was the most frequently used parameter to describe BP. BP variability (standard deviation, successive variability) after EVT was associated with worse functional outcome, especially in studies without specific BP targets after successful EVT. Lower BP values after successful EVT were associated with lower odds of sICH. Four studies evaluated the post-EVT BP impact on recanalized patients solely, with only one specifically addressing the impact of a TICI 2B vs. 2C. Interestingly, SBP reduction was inversely associated with worse outcomes in TICI 3 patients but not in TICI 2B patients, pointing to the potential value of BP management according to the exact TICI. Conclusions: BP post-EVT seems to be associated with worse functional outcomes and sICH. However, given the important heterogeneity depicted among the included studies, no decisive conclusion can be made from this systematic review, thus underlying the urgent need of randomized controlled trials evaluating this question.

Impact of leukoaraiosis or blood pressure on clinical outcome, mortality and symptomatic intracerebral hemorrhage after mechanical thrombectomy in acute ischemic stroke

“…Cho et al also demonstrated a negative effect of increased mean SBP and observed an increased influence of these parameters in successfully recanalized patients compared to non-recanalized patients 44 . Two meta-analysis described an association between the variability of the SBP and a poor clinical result 45 , 46 , but no association with the 90-day mortality 46 . Further meta-analyses confirmed a significant association of increased SBP after MT 47 or pre- and post-interventional 9 with a poor clinical result.…”

Assessment of Discrepancies Between Follow-up Infarct Volume and 90-Day Outcomes Among Patients With Ischemic Stroke Who Received Endovascular Therapy

“…Optimal BP parameters after EVT are uncertain; our findings showed that lower BP was favorably associated with functional outcome even among patients with large infarcts. 40 , 41 Whether lowering BP will translate to better outcomes remains unclear. Hyperglycemia occurs in approximately 40% of patients with acute ischemic stroke and is associated with worse outcomes.…”

“…These include BP control, glucose, and hemoglobin at 24 hours. Optimal BP parameters after EVT are uncertain; our findings showed that lower BP was favorably associated with functional outcome even among patients with large infarcts . Whether lowering BP will translate to better outcomes remains unclear.…”

Association of Contrast Enhancement After Reperfusion With Outcomes According to Blood Pressure Lowering in Patients With Acute Ischemic Stroke

“…This study provides Class IV evidence that for adults with contrast-enhancing lesions after successful EVT of an AIS, Values are expressed as n/no (%). 1 ORs were calculated using logistic regression models. 2Adjusted using IPTW where the propensity score was calculated with all parameters in Table 1.…”