Blood pressure management after endovascular thrombectomy: Insights of recent randomized controlled trials

Abstract

Background: The ideal blood pressure (BP) target in patients who undergo endovascular thrombectomy (EVT) with successful reperfusion is uncertain. Observational studies show that elevated BP during this period is associated with a higher risk of intracranial hemorrhage (ICH) and worse clinical outcomes. Several randomized controlled trials (RCTs) have explored whether intensive BP lowering improves clinical outcomes in these patients.

Aims: This review aims to summarize the recent RCTs that compare intensive and conventional BP management strategies following EVT and discuss the innovative directions to improve.

Result: The recently published RCTs failed to demonstrate the benefit of intensive BP control on the functional outcome and decreasing the risk of ICH. The complex mechanism in cerebral blood flow regulation and the inappropriate BP range chosen in RCTs may be the reasons behind the inconsistent results between observational studies and RCTs. Individualized BP management, reducing BP variability, and multi-stage BP management should be paid more attention in future exploration.

Conclusion: Intensive BP target did not improve clinical outcomes after successful EVT as compared with a conventional BP target. Further research is required to identify the optimal BP management strategy after reperfusion.

Keywords: acute ischemic stroke; blood pressure; endovascular thrombectomy; randomized controlled trials.

FIGURE 1

The potential risk of lower or higher blood pressure target after endovascular thrombectomy. In pathophysiology, a lower blood pressure target may impair cerebral perfusion, leading to ischemia and increased infarction (A). However, a higher blood pressure target may cause cerebral edema and cerebral hemorrhage (B). BP , blood pressure.