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Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke: A Randomized Clinical Trial

Fecha de publicación:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Camps-Renom P.
  • Guasch-Jiménez M.
  • Álvarez-Cienfuegos J.
  • López-Hernández N.
  • Rodríguez-Campello A.
  • Tejada-Meza H.
  • López-Mesonero L.
  • Albert-Lacal L.
  • Freijo-Guerrero M.M.
  • Flores A.
  • Cabezas-Rodríguez J.A.
  • Fernández-Vidal J.M.
  • Martínez-Domeño A.
  • Pérez De La Ossa N.
  • Ramos-Pachón A.
  • Aguilera-Simón A.
  • Marín R.
  • Ezcurra-Díaz G.
  • Lambea-Gil Á.
  • Silva Y.
  • Corona-García D.J.
  • Giralt-Steinhauer E.
  • Marta-Moreno J.
  • Vizcaya-Gaona J.A.
  • Sanz-Monllor A.
  • Luna A.
  • Ustrell X.
  • Moniche F.
  • Solà-Roca J.
  • Wang X.
  • Anderson C.S.
  • Prats-Sánchez L.
  • Martí-Fàbregas J.
  • Mathison Y.
  • Arenillas Lara J.F.
  • Millán M.
  • Puig Campmany M.
  • Branera J.
  • González Martínes J.P.
  • Dinia L.
  • Munuera del Cerro J.
  • Lozano Martínez A.
  • Granell E.
  • Domínguez Perea A.
  • Del Val I.
  • Borrego Escobar L.
  • Delgado Mederos R.
  • Domine M.C.
  • Coronel Coronel M.
  • Blanco Sanroman N.
  • Delgado Romeu M.
  • López Lombardía O.
  • Carbonell Fernández P.
  • Arriola J.
  • Mederer T.
  • Borrell M.
  • Sainz R.
  • Collet Vidiella R.
  • Pérez Pérez J.
  • Cortés Vicente E.
  • Carbayo Viejo Á.
  • Vesperinas A.
  • Pascual Goñi E.
  • Olmedo G.
  • Ruiz Barrio Í.
  • Llansó L.
  • Caballero M.
  • Aracil I.
  • Zhu N.
  • García J.
  • Alberti B.
  • Arranz R.
  • Vegas A.
  • Silva A.M.
  • Casco A.
  • Gauchia A.
  • López A.
  • Sanuy A.
  • Garriga B.
  • García Burón C.
  • Riquelme C.
  • Arcos E.
  • Ximenis E.
  • Hidalgo E.
  • Jiménez E.
  • Artiles E.
  • Millán E.
  • Serra G.
  • Déniz G.
  • Arranz G.
  • Martínez I.
  • Bargueño I.
  • Antón I.
  • Castelló J.
  • Alcaraz J.
  • Moscardó L.
  • Pérez L.
  • Benítez M.M.
  • Palomo M.E.
  • Guardia M.
  • Carreras M.
  • Safont M.
  • González N.
  • Garcia N.
  • Monterrey O.
  • de Gracia P.
  • Álvarez S.
  • El Ghrissat S.
  • Gracia T.
  • Jiménez Y.
  • Gambin L.
  • Rodríguez R.

Grupos

Abstract

Importance: Optimal blood pressure (BP) management after successful endovascular therapy for acute ischemic stroke remains uncertain, as intensive lowering has shown no benefit or potential harm in prior trials. Objective: To determine whether a reperfusion-guided systolic BP control strategy improves functional outcomes compared with guideline-recommended management after successful endovascular therapy for acute ischemic stroke. Design, Setting, and Participants: This investigator-initiated, multicenter, prospective, randomized, open-label clinical trial with blinded end point assessment was conducted among adults with acute ischemic stroke due to anterior circulation large-vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score =2b) after endovascular therapy at 11 comprehensive stroke centers in Spain between June 14, 2021, and October 1, 2025, with 90-day follow-up. Data analysis was conducted from February 1 to March 12, 2026. Interventions: Participants were randomly assigned (1:1) to a reperfusion-guided systolic BP strategy (140-160 mm Hg for mTICI score of 2b; 100-140 mm Hg for mTICI score of 2c/3) or guideline-recommended management (systolic BP <180 mm Hg) for 72 hours using antihypertensive agents or vasopressors as needed. Main Outcomes and Measures: The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days, assessed in the intention-to-treat population. Of 446 enrolled patients, 440 were included in the intention-to-treat analysis (mean age, 75 years; 53% women); 6 were excluded due to withdrawal or consent withdrawal. Results: Among 440 patients (mean [SD] age, 75 [12] years; 233 [53.0%] women), 215 were assigned to the intervention group and 225 to the control group. At 90 days, 129 patients (60.0%) in the intervention group and 106 (47.1%) in the control group achieved a favorable functional outcome (absolute risk difference, 13.3%; 95% CI, 4.1%-22.6%; P =.005). Hemorrhagic transformation occurred in 48 patients (22.3%) in the intervention group and 71 (31.6%) in the control group (odds ratio, 0.62; 95% CI, 0.41-0.95). The rates of symptomatic intracranial hemorrhage (3.5% vs 3.9%) and 90-day mortality (15.4% vs 15.6%) did not differ between groups. Serious adverse events occurred in 34 patients (15.8%) in the intervention group and 27 (12.0%) in the control group. Conclusions and Relevance: In this randomized clinical trial, a reperfusion-guided BP strategy improved functional outcomes and reduced hemorrhagic transformation without increasing major safety events, supporting a tailored approach to postthrombectomy BP management. © 2026 Camps-Renom P et al.

Datos de la publicación

ISSN/ISSNe:
2168-6149, 2168-6157

JAMA Neurology  AMER MEDICAL ASSOC

Tipo:
Article
Páginas:
-
PubMed:
42258192
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
6,278 SCImago ℠
Cuartil:
Q1 SCImago ℠

Citas Recibidas en Web of Science: 2

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