Standard Versus Intensive Blood Pressure Control in Acute Ischemic Stroke Patients Successfully Treated With Endovascular Thrombectomy: A Systemic Review and Meta-Analysis of Randomized Controlled Trials.

IF 6 1区 医学 Q1 CLINICAL NEUROLOGY Journal of Stroke Pub Date : 2024-01-01 Epub Date: 2024-01-30 DOI:10.5853/jos.2023.04119
Hyungjong Park, Sung-Il Sohn, Gwang Hyun Leem, Minho Kim, Yun Hak Kim, Tae-Jin Song
{"title":"Standard Versus Intensive Blood Pressure Control in Acute Ischemic Stroke Patients Successfully Treated With Endovascular Thrombectomy: A Systemic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Hyungjong Park, Sung-Il Sohn, Gwang Hyun Leem, Minho Kim, Yun Hak Kim, Tae-Jin Song","doi":"10.5853/jos.2023.04119","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and purpose: </strong>The optimal blood pressure (BP) control after successful endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) with large vessel occlusion (LVO) remains debatable. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy and safety of standard BP control (with systolic BP ≤180 mm Hg) versus intensive BP control (systolic BP <140 mm Hg) during the 24 hours after successful EVT in AIS with LVO.</p><p><strong>Methods: </strong>PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant trials. The crude odds ratio (OR) and 95% confidence interval (CI) were calculated and estimates using random-effects models were pooled. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD42023450673).</p><p><strong>Results: </strong>Four RCTs involving 1,559 participants were included. Regarding efficacy outcomes, intensive BP control was associated with a lower likelihood of functional independence (OR: 0.68; 95% CI: 0.51-0.91 for modified Rankin Scale [mRS] ≤2) and walking without assistance (OR: 0.65; 95% CI: 0.53-0.81 for mRS ≤3). For safety outcomes, consistent with the efficacy findings, intensive BP control was significantly associated with severe disability or death (mRS 5 or 6) (OR: 1.34; 95% CI: 1.07-1.69). However, there were no significant differences including all-cause mortality, any intracerebral hemorrhage (ICH), symptomatic ICH, parenchymal hematoma type 2, and stroke recurrence.</p><p><strong>Conclusion: </strong>While all four RCTs were conducted to demonstrate the superiority of intensive BP control over standard BP control, standard BP control may be beneficial for the outcome after EVT for AIS with LVO without increasing adverse safety outcomes. Caution should be needed with the application of intensive BP control during the 24 hours following successful recanalization after EVT.</p>","PeriodicalId":17135,"journal":{"name":"Journal of Stroke","volume":"26 1","pages":"54-63"},"PeriodicalIF":6.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10850446/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Stroke","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5853/jos.2023.04119","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/30 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Background and purpose: The optimal blood pressure (BP) control after successful endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) with large vessel occlusion (LVO) remains debatable. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluate the efficacy and safety of standard BP control (with systolic BP ≤180 mm Hg) versus intensive BP control (systolic BP <140 mm Hg) during the 24 hours after successful EVT in AIS with LVO.

Methods: PubMed, Scopus, the Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant trials. The crude odds ratio (OR) and 95% confidence interval (CI) were calculated and estimates using random-effects models were pooled. This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO ID: CRD42023450673).

Results: Four RCTs involving 1,559 participants were included. Regarding efficacy outcomes, intensive BP control was associated with a lower likelihood of functional independence (OR: 0.68; 95% CI: 0.51-0.91 for modified Rankin Scale [mRS] ≤2) and walking without assistance (OR: 0.65; 95% CI: 0.53-0.81 for mRS ≤3). For safety outcomes, consistent with the efficacy findings, intensive BP control was significantly associated with severe disability or death (mRS 5 or 6) (OR: 1.34; 95% CI: 1.07-1.69). However, there were no significant differences including all-cause mortality, any intracerebral hemorrhage (ICH), symptomatic ICH, parenchymal hematoma type 2, and stroke recurrence.

Conclusion: While all four RCTs were conducted to demonstrate the superiority of intensive BP control over standard BP control, standard BP control may be beneficial for the outcome after EVT for AIS with LVO without increasing adverse safety outcomes. Caution should be needed with the application of intensive BP control during the 24 hours following successful recanalization after EVT.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
成功接受血管内血栓切除术治疗的急性缺血性脑卒中患者的标准血压控制与强化血压控制:随机对照试验的系统回顾和元分析》。
背景和目的:大血管闭塞(LVO)急性缺血性卒中(AIS)血管内血栓切除术(EVT)成功后的最佳血压(BP)控制仍存在争议。我们对评估标准血压控制(收缩压≤180 mm Hg)与强化血压控制(收缩压方法)的有效性和安全性的随机对照试验(RCT)进行了系统回顾和荟萃分析:检索了 PubMed、Scopus、Cochrane 对照试验中央登记册和 Embase,以确定相关试验。计算出粗略的几率比(OR)和 95% 的置信区间(CI),并使用随机效应模型对估计值进行汇总。该荟萃分析遵循了系统综述和荟萃分析首选报告项目(PRISMA)指南(PROSPERO ID:CRD42023450673):结果:共纳入四项 RCT,涉及 1,559 名参与者。在疗效结果方面,强化血压控制与较低的功能独立可能性(OR:0.68;95% CI:0.51-0.91,修改后兰金量表[mRS]≤2)和无需协助的行走(OR:0.65;95% CI:0.53-0.81,mRS≤3)相关。安全性结果与疗效结果一致,强化血压控制与严重残疾或死亡(mRS 5 或 6)显著相关(OR:1.34;95% CI:1.07-1.69)。然而,在全因死亡率、任何脑内出血(ICH)、症状性 ICH、2 型实质血肿和中风复发等方面没有明显差异:结论:虽然所有四项研究都证明了强化血压控制优于标准血压控制,但标准血压控制可能有利于AIS伴LVO的EVT术后疗效,且不会增加不良的安全性结果。在 EVT 成功再通后的 24 小时内应用强化血压控制需谨慎。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Journal of Stroke
Journal of Stroke CLINICAL NEUROLOGYPERIPHERAL VASCULAR DISE-PERIPHERAL VASCULAR DISEASE
CiteScore
11.00
自引率
3.70%
发文量
52
审稿时长
12 weeks
期刊介绍: The Journal of Stroke (JoS) is a peer-reviewed publication that focuses on clinical and basic investigation of cerebral circulation and associated diseases in stroke-related fields. Its aim is to enhance patient management, education, clinical or experimental research, and professionalism. The journal covers various areas of stroke research, including pathophysiology, risk factors, symptomatology, imaging, treatment, and rehabilitation. Basic science research is included when it provides clinically relevant information. The JoS is particularly interested in studies that highlight characteristics of stroke in the Asian population, as they are underrepresented in the literature. The JoS had an impact factor of 8.2 in 2022 and aims to provide high-quality research papers to readers while maintaining a strong reputation. It is published three times a year, on the last day of January, May, and September. The online version of the journal is considered the main version as it includes all available content. Supplementary issues are occasionally published. The journal is indexed in various databases, including SCI(E), Pubmed, PubMed Central, Scopus, KoreaMed, Komci, Synapse, Science Central, Google Scholar, and DOI/Crossref. It is also the official journal of the Korean Stroke Society since 1999, with the abbreviated title J Stroke.
期刊最新文献
Inpatient Outcomes of Cerebral Venous Thrombosis in Patients With Malignancy Throughout the United States. Mechanical Thrombectomy Versus Intravenous Thrombolysis in Distal Medium Vessel Acute Ischemic Stroke: A Multinational Multicenter Propensity Score-Matched Study. Global Estimates of Reported Vaccine-Associated Ischemic Stroke for 1969-2023: A Comprehensive Analysis of the World Health Organization Global Pharmacovigilance Database. Ethnic Differences in the Safety and Efficacy of Tenecteplase Versus Alteplase for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Early Improvement in Interstitial Fluid Flow in Patients With Severe Carotid Stenosis After Angioplasty and Stenting.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1