Intensive versus less intensive blood pressure targets after mechanical thrombectomy in acute ischemic stroke: a systematic review and network meta-analysis

Hemodynamic management, specifically blood pressure, is essential to reduce mortality and preserve functional capacity. However, the literature is uncertain about the best blood pressure target to be adopted after performing mechanical thrombectomy in patients with acute ischemic stroke. Randomized...

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Bibliographic Details
Published in:Neurological sciences 2025, Vol.46 (1), p.89-97
Main Authors: de Oliveira, Bruno Felipe Santos, Bispo, Rafaela Góes, dos Santos, Bruna Helena Ribeiro Araújo, Pereira, Luiz Filippe Vago, Assis, Gabriele Eliza, Abbade, Pedro Fernandes, Cazé, Ana Beatriz, Neves, Beatriz Malaquias, Oliveira-Filho, Jamary
Format: Article
Language:English
Subjects:
Blood pressure
Blood Pressure - physiology
Clinical trials
Hemorrhage
Humans
Ischemia
Ischemic Stroke - physiopathology
Ischemic Stroke - surgery
Ischemic Stroke - therapy
Medicine
Medicine & Public Health
Meta-analysis
Network Meta-Analysis
Neurology
Neuroradiology
Neurosurgery
Psychiatry
Randomized Controlled Trials as Topic
Reperfusion
Review Article
Stroke
Thrombectomy - methods
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Summary:Hemodynamic management, specifically blood pressure, is essential to reduce mortality and preserve functional capacity. However, the literature is uncertain about the best blood pressure target to be adopted after performing mechanical thrombectomy in patients with acute ischemic stroke. Randomized clinical trials that compared blood pressure goals after mechanical thrombectomy were searched in the following databases: MEDLINE/PubMed, Embase, Scopus, Biomedcentral, and Cochrane Library. The last search was on September 19, 2023. The results obtained were used to construct network meta-analyses. A total of 1556 participants were enrolled from 4 randomized controlled trials (OPTIMAL-BP, ENCHANTED2/MT, BP-TARGET, BEST-II). The last article was not included in the network meta-analysis because it did not have common blood pressure targets. The outcomes compared were: mRS (modified Rankin scale), eTICI/mTICI scale scores, symptomatic and any intracerebral hemorrhage, post-intervention NIHSS, and post-intervention infarct volume. The outcomes using the mRS scale showed that better outcomes were reached with less intensive blood pressure targets when comparing 
ISSN:1590-1874
1590-3478
1590-3478
DOI:10.1007/s10072-024-07647-w