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
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.
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