Intensive versus standard blood pressure management after endovascular therapy in acute ischemic stroke: a systematic review and meta-analysis.

Endovascular thrombectomy (EVT) has improved the therapy of acute ischemic stroke, patients still have functional impairments after reperfusion. This updated meta-analysis assesses whether intense blood pressure (BP) management following successful EVT enhances results and reduces problems associated with reperfusion. PubMed, Embase, and Cochrane databases were systematically searched using relevant keywords from inception until July 2025. A total of five studies were included after final screening. Outcomes were reported as excellent clinical outcomes, functional independence, all-cause mortality at 90 days, any intracranial hemorrhage within 24 h, etc. Interstudy heterogeneity was assessed using I 2 and X 2 statistics (I 2 > 50% = significant heterogeneity). Statistical calculations used Review Manager 5.4.1, with a P-value of <0.05 indicating statistical significance. A moderate but substantial improvement in neurological outcomes (mean National Institutes of Health Stroke Scale difference = 1.07; P = 0.03) and functional independence (mRS modified Rankin Scale 0-2) was both markedly enhanced by intensive BP control (RR = 0.82; 95% CI: 0.74-0.91; P = 0.0002). It did not, however, have a significant effect on all-cause death at 90 days, symptomatic or any cerebral bleeding, stroke recurrence, or excellent clinical outcomes (mRS 0-1). A significant correlation was seen between a greater incidence of hypotensive episodes and severe BP lowering (RR = 1.77; P < 0.00001). It also raises the risk of hypotension without reducing the danger of hemorrhage or death. Following EVT, intense BP control may enhance early neurological results and functional independence, but it also raises the risk of hypotension without reducing death or hemorrhage.