Neurology: Optimizing the early blood pressure management of intravascular thrombectomy for acute ischemic stroke can improve patient prognosis

Although blood vessels within the thrombus excision (the EVT) is so far the sole can be improved by the large intracranial vessel occlusion (the LVO) acute ischemia-induced stroke (AIS) procedural treatment morbidity and mortality, but about half The patient died or was permanently disabled after successful recanalization after endovascular treatment
.

Although blood vessels within the thrombus excision (the EVT) is so far the sole can be improved by the large intracranial vessel occlusion (the LVO) acute ischemia-induced stroke (AIS) procedural treatment morbidity and mortality, but about half The patient died or was permanently disabled after successful recanalization after endovascular treatment
.

Vessels within the thrombus excision (the EVT) vascular the thrombus excision (the EVT) vascular thrombosis large intracranial vessel occlusion (the LVO) large intracranial vessel occlusion (the LVO) Stroke

Blood pressure (BP) management after EVT may be a potentially modifiable parameter to improve the good prognosis of patients receiving acute reperfusion therapy.
At present, there are limited data to guide the management of BP in LVO patients undergoing EVT, and there is no clear consensus on the optimal blood pressure goal before, during, and after EVT surgery.
Although current guidelines recommend a systolic blood pressure ≤ threshold of 180 mmHg and a diastolic blood pressure of 105 mmHg during EVT and within 24 hours after treatment, they also emphasize the lack of randomized trials to confirm this.
Therefore, these blood pressure parameters are adopted from the intravenous thrombolysis test.
In the intravenous thrombolysis test, the possibility of successful recanalization is small, and real-time confirmation of arterial recanalization is not applicable.
In addition, the practice of BP goals after EVT has changed a lot in the real world.

EVT EVT Blood pressure (BP) management after EVTmay be a potentially modifiable parameter to improve the good prognosis of patients receiving acute reperfusion therapy.

At present, there are limited data to guide the management of BP in LVO patients undergoing EVT, and there is no clear consensus on the optimal blood pressure goal before, during, and after EVT surgery.
Although current guidelines recommend a systolic blood pressure ≤ threshold of 180 mmHg and a diastolic blood pressure of 105 mmHg during EVT and within 24 hours of treatment, they also emphasize the lack of randomized trials to confirm this.
Therefore, these blood pressure parameters are adopted from the intravenous thrombolysis test.
In the intravenous thrombolysis test, the possibility of successful recanalization is low, and real-time confirmation of arterial recanalization is not applicable.
In addition, the practice of BP goals after EVT has changed a lot in the real world.

      In a paired meta-analysis of a recent observational cohort study, the prognosis of patients was more closely correlated with blood pressure levels after EVT than blood pressure measurements before or during the perioperative period

      This study included AIS patients over 18 years old, LVO patients who received successful or failed EVT treatment, and provided a single or average 24-hour systolic blood pressure value after the end of the EVT procedure, the study is eligible
.

Individual patient data in all studies were analyzed using generalized linear mixed-effects models

      This study included AIS patients over 18 years old, LVO patients who received successful or failed EVT treatment, and provided a single or average 24-hour systolic blood pressure value after the end of the EVT procedure, the study is eligible

• A total of 5,874 patients from 7 published studies (mean age: 69±14 years, 50% were women, and the median NIHSS at admission was 16)
  .
  
• Within 24 hours after the end of EVT, the average systolic blood pressure level per 10 mmHg increased and the probability of functional improvement was lower (unadjusted ordinary OR=0.
  
  82, 95%CI: 0.
  80~0.
  85; adjusted ordinary OR=0.
  
        The increase in the average systolic blood pressure level within 24 hours after EVT is independently associated with the increased chances of symptomatic intracranial hemorrhage, early neurological deterioration, 3-month mortality, and 3-month poor prognosis
  
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