Systolic blood pressure targets after successful endovascular thrombectomy: a network meta-analysis of randomized controlled trials.

BACKGROUND

Uncertainty persists regarding the optimal systolic blood pressure (SBP) target after thrombectomy, as systemic blood pressure may affect the penumbra and associated microcirculatory perfusion. We evaluated the impact of different SBP targets on outcomes and the dose-response relationship between actual 24-hour mean SBP and functional outcomes.

METHODS

We systematically reviewed studies comparing SBP targets after thrombectomy. Bayesian network meta-analysis assessed functional independence and safety. Multi-threshold sensitivity analyses tested the proportional odds assumption across disability levels. Study-level meta-regression explored the association between 24-hour mean SBP and functional outcomes.

RESULTS

Eight studies were included. The < 180 mmHg target ranked highest for functional independence (SUCRA = 87.3% (50.0%-100.0%)), while < 140 mmHg (SUCRA = 26.3%, OR = 1.65 (1.03-2.54)) and < 120 mmHg (SUCRA = 17.7%, OR = 1.75 (1.14-2.71)) were associated with worse outcomes, and the certainty of the evidence was high. No significant differences in symptomatic intracranial hemorrhage or 90-day mortality were observed. Among six study-level comparisons, five violated the proportional odds assumption, indicating effect heterogeneity across disability levels.An exploratory group-level meta-regression showed that, within the observed range of 117-139 mmHg, higher actual SBP was associated with a higher odds ratio for functional independence at the study group level (OR = 1.028 (1.015-1.041)).

CONCLUSIONS

After successful recanalization, clinicians should avoid excessive SBP reduction. Future studies should consider reperfusion status, the burden of ischemic injury, and tissue perfusion to determine individualized blood pressure targets.