Deans' stroke musings: Impact of Intensive Blood Pressure Lowering After Multiple-Attempt Endovascular Thrombectomy : a secondary analysis of the OPTIMAL-BP trial

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 24, 2024

Impact of Intensive Blood Pressure Lowering After Multiple-Attempt Endovascular Thrombectomy : a secondary analysis of the OPTIMAL-BP trial

So we still don't have a blood pressure management protocol post stroke. Hope your competent? doctor guesses correctly because the poor outcome happens to you! Your doctor gets off scot-free and still gets paid!

Impact of Intensive Blood Pressure Lowering After Multiple-Attempt Endovascular Thrombectomy : a secondary analysis of the OPTIMAL-BP trial

Jae Wook Jung https://orcid.org/0000-0002-9219-8522, Kwang Hyun Kim, and Hyo Suk Nam https://orcid.org/0000-0002-4415-3995 hsnam@yuhs.acView all authors and affiliations

Accepted Manuscripts

https://doi.org/10.1177/17474930241265652

Abstract

Background:

Multiple attempts of thrombectomy have been linked to a higher risk of intracerebral hemorrhage and worsened functional outcomes, potentially influenced by blood pressure (BP) management strategies. Nonetheless, the impact of intensive BP management following successful recanalization through multiple attempts remains uncertain.

Aims:

This study aimed to investigate whether conventional and intensive BP management differentially affect outcomes according to multiple-attempt recanalization (MAR) and first-attempt recanalization (FAR) groups.

Methods:

In this secondary analysis of the OPTIMAL-BP trial, which was a comparison of intensive (systolic BP target <140 mm Hg) and conventional (systolic BP target 140-180 mm Hg) BP managements during the 24 hours after successful recanalization, we included intention-to-treat population of the trial. Patients were divided into the MAR and the FAR groups. We examined a potential interaction between the number of thrombectomy attempts (MAR and FAR groups) and the effect of BP managements on clinical and safety outcomes. The primary outcome was functional independence at 3 months. Safety outcomes were symptomatic intracerebral hemorrhage within 36 hours and mortality within 3 months.

Results:

Of the 305 patients (median 75 years), 102 (33.4%) were in the MAR group and 203 (66.6%) were in the FAR group. The intensive BP management was significantly associated with a lower rate of functional independence in the MAR group (intensive, 32.7% vs. conventional, 54.9%, adjusted OR 0.33, 95% CI 0.12-0.90, p = 0.03). In the FAR group, the proportion of patients with functional independence was not significantly different between the BP managements (intensive, 42.5% vs. conventional, 54.2%, adjusted OR 0.73, 95% CI 0.38-1.40). Incidences of symptomatic intracerebral hemorrhage and mortality rates were not significantly different according to the BP managements in both MAR and FAR groups.

Conclusions:

Among stroke patients who received multiple attempts of thrombectomy, intensive BP management for 24 hours resulted in a reduced chance of functional independence at 3 months and did not reduce symptomatic intracerebral hemorrhage following successful reperfusion.