Optimal Systolic Blood Pressure Control After Thrombectomy in Acute Ischemic Stroke: A Systematic Review and Meta-analysis.

IF 1.9 4区医学 Q3 CLINICAL NEUROLOGY

Annals of Indian Academy of Neurology Pub Date : 2025-05-07 DOI:10.4103/aian.aian_1087_24

Baikuntha Panigrahi, Rohit Bhatia, Partha Haldar, Risha Sarkar, Imnameren Longkumer

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引用次数: 0

Abstract

Background and objectives: The optimal systolic blood pressure (SBP) control after endovascular thrombectomy (EVT) is unclear. This study aimed to determine whether intensive SBP control (<140 mmHg) within 24 h post-EVT, compared to conventional management (<180 mmHg), leads to a better functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 90 days.

Methods: Following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we searched databases (PubMed, Scopus, EMBASE, Google Scholar, Web of Science) for English language articles up to March 15, 2024. We included randomized controlled trials (RCTs) and observational studies comparing intensive versus conventional SBP control up to 24 h post-EVT. Studies without separate primary outcome data and case series/reports were excluded. The primary outcome was functional independence (mRS 0-2 at 90 days).

Results: Twelve studies (n = 5152 patients; five RCTs and seven observational studies) were included, and a primary analysis of the RCTs, along with a secondary exploratory analysis of the observational studies were conducted. The analysis of RCTs favored conventional control for the primary outcome (risk ratio [RR]- 0.81; 95% confidence interval [CI]- 0.73-0.90; P < 0.0001). Mortality rates (RR- 1.14, 95% CI- 0.89-1.45; P = 0.29) and the risk of symptomatic intracranial hemorrhage (RR- 1.10, 95% CI- 0.77-1.58; P = 0.60) were similar in both groups. The secondary exploratory analysis of observational data favored the intensive arm for the primary outcome (RR- 1.28, 95% CI- 1.17-1.41; P < 0.00001).

Conclusions: Our primary analysis of RCTs showed that intensive control was associated with poorer functional outcomes, with no significant impact on mortality rate or the risk of symptomatic intracranial hemorrhage. Although observational studies suggested better outcomes with intensive control, we recommend conventional management based on Level 1 evidence from RCTs.PROSPERO Registration no- CRD42023463173.

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急性缺血性卒中取栓后最佳收缩压控制：系统回顾和荟萃分析。

背景和目的：血管内取栓（EVT）后的最佳收缩压（SBP）控制尚不清楚。本研究旨在确定是否强化收缩压控制（方法：遵循系统评价和meta分析指南的首选报告项目），我们检索了截至2024年3月15日的英文文章数据库（PubMed, Scopus， EMBASE，谷歌Scholar， Web of Science）。我们纳入了随机对照试验（rct）和观察性研究，比较了evt后24小时强化和常规收缩压控制。没有单独的主要结局数据和病例系列/报告的研究被排除在外。主要终点是功能独立性（90天mRS 0-2）。结果：12项研究(n = 5152例患者；纳入5项随机对照试验和7项观察性研究)，对随机对照试验进行初步分析，并对观察性研究进行二次探索性分析。rct分析表明，主要结局倾向于传统对照(风险比[RR]- 0.81；95%置信区间[CI]- 0.73-0.90；P < 0.0001)。死亡率(RR- 1.14, 95% CI- 0.89-1.45；P = 0.29)和症状性颅内出血的风险(RR- 1.10, 95% CI- 0.77-1.58；P = 0.60)，两组差异无统计学意义。观察数据的二次探索性分析支持强化组的主要结局(RR- 1.28, 95% CI- 1.17-1.41；P < 0.00001)。结论：我们对随机对照试验的初步分析显示，强化控制与较差的功能结局相关，对死亡率或症状性颅内出血的风险没有显著影响。虽然观察性研究表明强化控制的结果更好，但我们推荐基于rct一级证据的常规管理。普洛斯彼罗注册号：CRD42023463173。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Indian Academy of Neurology Nervous System Diseases-

CiteScore

2.20

自引率

11.80%

发文量

293

审稿时长

29 weeks

期刊介绍： The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.