Intensive blood pressure lowering in acute stroke with intracranial stenosis post-thrombectomy: A secondary analysis of the OPTIMAL-BP trial.
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Kim Kwang Hyun, Yun Jaeseob, Jung Jae Wook, Kim Young Dae, Heo JoonNyung, Lee Hyungwoo, Choi Jin Kyo, Lee Il Hyung, Lim In Hwan, Hong Soon-Ho, Baik Minyoul, Kim Byung Moon, Kim Dong Joon, Shin Na-Young, Cho Bang-Hoon, Ahn Seong Hwan, Park Hyungjong, Sohn Sung-Il, Hong Jeong-Ho, Song Tae-Jin, Chang Yoonkyung, Kim Gyu Sik, Seo Kwon-Duk, Lee Kijeong, Chang Jun Young, Seo Jung Hwa, Lee Sukyoon, Baek Jang-Hyun, Cho Han-Jin, Shin Dong Hoon, Kim Jinkwon, Yoo Joonsang, Lee Kyung-Yul, Jung Yo Han, Hwang Yang-Ha, Kim Chi Kyung, Kim Jae Guk, Lee Chan Joo, Park Sungha, Lee Hye Sun, Kwon Sun U, Bang Oh Young, Heo Ji Hoe, Nam Hyo Suk
Аннотация
AIMS: We aimed to assess whether ICAS affects the outcomes of intensive BP management after successful EVT.
METHODS: We conducted a secondary analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control trial, which enrolled participants from June 2020 to November 2022. Patients with anterior circulation large vessel occlusion (LVO) were stratified into ICAS-related and embolic LVO groups. Clinical outcomes for intensive (target systolic BP < 140 mm Hg) and conventional BP management (target systolic BP = 140-180 mm Hg) were analyzed in each group. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0 to 2 at 3 months. Safety outcomes included symptomatic intracerebral hemorrhage within 36 h and stroke-related death within 3 months.
RESULTS: Among 192 patients, 59 were in the ICAS-related LVO group, and 133 were in the embolic LVO group. In the ICAS-related LVO group, the rate of achieving a favorable outcome at 3 months was 37.5% with intensive BP management and 55.6% with conventional management (adjusted odds ratio (OR) = 0.49 (95% confidence interval (CI) = 0.14 to 1.75); P = 0.27). In the embolic LVO group, these rates were 29.9% and 42.4%, respectively (adjusted OR = 0.64 (95% CI = 0.28 to 1.45); P = 0.29). No significant interaction was found (P for interaction = 0.68). In addition, the ICAS-related LVO group receiving intensive BP management had lower rates of successful reperfusion at 24 h compared to conventional management (67.7% vs. 91.7%; P = 0.03), while no significant difference was found in the embolic LVO group. A significant interaction effect on successful reperfusion at 24 h was observed between ICAS-related and embolic LVO groups (P for interaction = 0.04). No significant differences in safety outcomes were observed between intensive BP management and conventional management within both ICAS-related LVO and embolic LVO groups.
CONCLUSIONS: ICAS did not significantly affect outcomes of intensive BP management within 24 h after successful EVT. After successful reperfusion by EVT, intensive BP management should be avoided regardless of ICAS presence.
DATA ACCESS STATEMENT: The data that support the findings of this study are available from the corresponding author upon reasonable request.