Systolic blood pressure reduction strategies in acute ischemic stroke patients following endovascular thrombectomy: a systematic review and meta-analysis

Mohammed Maan Al-Salihi; Syed A Gillani; Ram Saha; Mouhammad A Jumaa; Syed F Zaidi; Farhan Siddiq; Camilo R Gomez; Mikael Mazhigi; Adnan I Qureshi

doi:10.1016/j.jstrokecerebrovasdis.2024.107724

Systolic blood pressure reduction strategies in acute ischemic stroke patients following endovascular thrombectomy: a systematic review and meta-analysis

J Stroke Cerebrovasc Dis. 2024 Apr 16;33(7):107724. doi: 10.1016/j.jstrokecerebrovasdis.2024.107724. Online ahead of print.

Authors

Mohammed Maan Al-Salihi¹, Syed A Gillani², Ram Saha³, Mouhammad A Jumaa⁴, Syed F Zaidi⁴, Farhan Siddiq⁵, Camilo R Gomez², Mikael Mazhigi⁶, Adnan I Qureshi²

Affiliations

¹ Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA. Electronic address: mohammed.wwt@gmail.com.
² Department of Neurology, University of Missouri, Columbia, Missouri, USA.
³ Department of Neurology, Schoold of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
⁴ Department of Neurology, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.
⁵ Department of Neurosurgery, University of Missouri, Columbia, Missouri, USA.
⁶ Department of Interventional Neuroradiology, Rothschild Foundation, Paris, France.

PMID: 38636831
DOI: 10.1016/j.jstrokecerebrovasdis.2024.107724

Abstract

Background and aims: There is no clear consensus on ideal systolic blood pressure (SBP) target post-endovascular thrombectomy (EVT) in patients with acute ischemic stroke. This study intends to investigate the relationship between reducing SBP and clinical outcomes and to determine the therapeutic efficacy of moderate and intensive SBP reduction post EVT.

Methods: A comprehensive search was conducted across five electronic databases to identify studies relevant to our analysis. Data from these studies were then analyzed using pooled relative risk (RR) along with their corresponding 95 % confidence intervals (CI) for our categorical outcomes. functional independence at 90 days post-EVT was defined as a modified Rankin score (mRS) 0-2.

Results: Our meta-analysis included eight studies with 2922 patients: 1376 patients were treated with intensive SBP reduction, 306 with moderate SBP reduction, and 1243 with standard SBP reduction. There was no difference in the risk of functional independence at 90 days post-EVT with both intensive-SBP reduction (target 120-140 mmHg, relative risk (RR) =1.05, 95 % CI 0.82, 1.34, p = 0.72) and moderate-SBP reduction (>160 mm Hg) (RR= 0.95, 95 % CI 0.69, 1.31, p = 0.76) compared with standard SBP reduction (>180 mm Hg). The risk of symptomatic intracranial hemorrhage (sICH) did not significantly differ between standard-SBP reduction and intensive-SBP reduction (RR = 0.93, 95 % CI 0.66, 1.31, p = 0.36) or moderate-SBP reduction (0.72 (95 % CI [0.28, 1.87], p = 0.50) groups, respectively. Intensive-SBP reduction significantly decreased the risk of hemicraniectomy.

Conclusions: We did not identify any difference in functional independence at 90 days in acute ischemic stroke patients with either intensive-SBP reduction or moderate-SBP reduction compared with standard SBP reduction post-EVT.

Keywords: Acute Ischemic Stroke; Endovascular thrombectomy; Meta-analysis; Reduction Strategies; Systolic Blood pressure reduction.