Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke: A Randomized Clinical Trial.
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Camps-Renom Pol, Guasch-Jiménez Marina, Álvarez-Cienfuegos Juan, López-Hernández Nicolás, Rodríguez-Campello Ana, Tejada-Meza Herbert, López-Mesonero Luis, Albert-Lacal Laura, Freijo-Guerrero Mari Mar, Tarruella-Hernández Diana, Flores Alan, Cabezas-Rodríguez Juan Antonio, Fernández-Vidal Joan Miquel, Martínez-Domeño Alejandro, Pérez de la Ossa Natalia, Ramos-Pachón Anna, Aguilera-Simón Ana, Marín Rebeca, Ezcurra-Díaz Garbiñe, Lambea-Gil Álvaro, Silva Yolanda, Corona-García Diego José, Giralt-Steinhauer Eva, Marta-Moreno Javier, Vizcaya-Gaona Jesús Alberto, Sanz-Monllor Ainara, Luna Alain, López Morales Mikahela, Ustrell Xavier, Moniche Francisco, Solà-Roca Judit, Wang Xia, Anderson Craig S, Prats-Sánchez Luis, Martí-Fàbregas Joan, HOPE Study Group
Аннотация
OBJECTIVE: To determine whether a reperfusion-guided systolic BP control strategy improves functional outcomes compared with guideline-recommended management after successful endovascular therapy for acute ischemic stroke.
DESIGN, SETTING, AND PARTICIPANTS: This investigator-initiated, multicenter, prospective, randomized, open-label clinical trial with blinded end point assessment was conducted among adults with acute ischemic stroke due to anterior circulation large-vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2b) after endovascular therapy at 11 comprehensive stroke centers in Spain between June 14, 2021, and October 1, 2025, with 90-day follow-up. Data analysis was conducted from February 1 to March 12, 2026.
INTERVENTIONS: Participants were randomly assigned (1:1) to a reperfusion-guided systolic BP strategy (140-160 mm Hg for mTICI score of 2b; 100-140 mm Hg for mTICI score of 2c/3) or guideline-recommended management (systolic BP <180 mm Hg) for 72 hours using antihypertensive agents or vasopressors as needed.
MAIN OUTCOMES AND MEASURES: The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days, assessed in the intention-to-treat population. Of 446 enrolled patients, 440 were included in the intention-to-treat analysis (mean age, 75 years; 53% women); 6 were excluded due to withdrawal or consent withdrawal.
RESULTS: Among 440 patients (mean [SD] age, 75 [12] years; 233 [53.0%] women), 215 were assigned to the intervention group and 225 to the control group. At 90 days, 129 patients (60.0%) in the intervention group and 106 (47.1%) in the control group achieved a favorable functional outcome (absolute risk difference, 13.3%; 95% CI, 4.1%-22.6%; P = .005). Hemorrhagic transformation occurred in 48 patients (22.3%) in the intervention group and 71 (31.6%) in the control group (odds ratio, 0.62; 95% CI, 0.41-0.95). The rates of symptomatic intracranial hemorrhage (3.5% vs 3.9%) and 90-day mortality (15.4% vs 15.6%) did not differ between groups. Serious adverse events occurred in 34 patients (15.8%) in the intervention group and 27 (12.0%) in the control group.
CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, a reperfusion-guided BP strategy improved functional outcomes and reduced hemorrhagic transformation without increasing major safety events, supporting a tailored approach to postthrombectomy BP management.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04892511.