BP Targets After Stroke Thrombectomy: Individualization Needed?

 Your doctor obviously hasn't though through blood pressure at all. Lowering too much means the penumbra will die quicker because of lack of oxygenated blood. Can your competent? doctor think at all about how to get you recovered? Ask him/her FOR EXACT SPECIFICS, doesn't have them is a sign of gross incompetence!

BP Targets After Stroke Thrombectomy: Individualization Needed?

Results of a new trial have re-awakened the possibility that blood pressure (BP) reduction following thrombectomy in patients with acute ischemic stroke (AIS) can be beneficial but with the caveat that BP targets may have to be individualized depending on patient-specific characteristics.

The HOPE trial showed that BP management intervention, with different targets for various levels of reperfusion achieved, improved functional outcomes after successful endovascular therapy.

This is the first clinical trial to demonstrate a benefit from BP reduction after thrombectomy; previous studies of intensive BP lowering — most conducted in Asia — showed either no benefit or even potential harm.

“Our trial reopens the debate about blood pressure lowering post-thrombectomy,” said lead investigator Pol Camps-Renom, MD, PhD, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Article Key Points

The HOPE trial suggests that individualized blood pressure targets post-thrombectomy may improve outcomes in acute ischemic stroke patients. The study found better functional outcomes and lower hemorrhagic transformation rates with tailored BP management, highlighting the need for personalized treatment strategies.

However, he cautioned that the findings should be considered hypothesis-generating rather than practice-changing, noting that other studies reinforcing the point that other trials have failed to show benefit with intensive BP lowering after thrombectomy but added that the results “definitely give information about key factors that can be incorporated into future trials.”

“I think the idea that one size will not fit all patients is probably the way forward and that blood pressures will be individualized based on patient characteristics in future. But it is too premature to act on these data at present,” he added.

The study was presented on May 6 at the European Stroke Organization Conference (ESOC) 2026.

Hazard if Not Fully Reperfused?

Compared with previous trials of intensive BP lowering after thrombectomy, the HOPE trial used different BP targets according to the degree of reperfusion achieved at the end of the procedure.

“We did this because we were concerned about blood circulation in patients with incomplete reperfusion,” Camps-Renom noted.

He cited data suggesting that patients with incomplete reperfusion after thrombectomy rely more heavily on collateral circulation to maintain cerebral blood flow, raising concerns that overly aggressive BP lowering in these patients could compromise collateral perfusion and prove harmful.

The trial was therefore designed with two different BP treatment targets. Conducted at 11 stroke centres in Spain, the HOPE trial enrolled patients with anterior circulation AIS due to intracranial large vessel occlusion within 24 hours of symptom onset who achieved successful recanalization after endovascular thrombectomy, defined as modified treatment in cerebral infarction (mTICI) 2b or higher.

A total of 440 patients were randomized to receive either protocol-driven or guideline-recommended BP management. In the intervention arm, systolic BP targets were individualized according to final reperfusion status.

For participants with good reperfusion after thrombectomy (mTICI 2c/3, equating to reperfusion of 90%-100%), a systolic BP target of 100-140 mg Hg was recommended. In contrast, those with incomplete reperfusion (mTICI 2b flow, indicating a reperfusion of 50%-90%), a target of 140-160 mm Hg was advised.

Randomization to the trial BP intervention protocol or standard guideline-based management began 1 hour after the final angiographic series, followed by an additional hour to achieve the assigned systolic BP target.

The intervention was then maintained for 72 hours and included antihypertensive therapy or vasopressor support, as needed.

Why HOPE Succeeded

Results showed that the primary endpoint — a favorable functional outcome (modified Rankin Scale score of 0-2 at 90 days) was achieved in 60.0% of patients in the intervention group vs 46.7% in the control group (OR, 1.71; 95% CI, 1.17-2.50; P = .005).