Abstract WP196: Blood Pressure After Endovascular Therapy: A Systematic Review and Metanalysis of Randomized Control Trials

Abstract

Background and Objectives: There are limited data evaluating the optimum blood pressure (BP) goal post mechanical thrombectomy (MT) and its effect on outcomes of patients with large vessel occlusions (LVO). The objective of this study was to compare the efficacy and safety of intensive versus less intensive blood pressure control after reperfusion with MT via a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: We searched the PubMed, and Embase to obtain articles related to blood pressure control post MT through September, 2023. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 3 months. Effect sizes were computed as odd ratio (OR) with random-effect or fixed-effect models. Results: Four Randomized Clinical Trials (RCTs) with 1566 patients (762 randomized into intensive blood pressure control vs. 806 randomized into loess intensive blood pressure control) were included. The RCT analysis showed that the likehood of functional independence was less in the more intensive treatment group compared with the less intensive treatment group functional independence (mRS 0-2: OR 0.66, 95% CI 0.54-0.89, P < 0.001). There was no significant increasing the risk of symptomatic intracranial hemorrhage (sICH: OR 1.14, 95% CI: 0.77-1.69, P = 0.51), or mortality ( mortality 1.22, 95% CI: 0.90-1.66, P =0.19). Conclusion: This systematic review and meta-analysis indicate that in patients who achieved successful MT for acute ischemic stroke with LVO, intensive BP control was associated with lower likehood of functional independence at 3 months without significant difference in sICH or mortality risk. Results of upcoming RCTs may provide further insight.