Blood pressure goals after mechanical thrombectomy: a moving target

Mechanical thrombectomy markedly improves the outcomes of patients with stroke due to large-vessel occlusion. Despite preventing disability in 12·5–50% of patients, about half of patients treated with mechanical thrombectomy have disability or die after the procedure. 1 Goyal M Menon BK van Zwam WH et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016; 387: 1723-1731 Summary Full Text Full Text PDF PubMed Scopus (4664) Google Scholar Blood pressure management after mechanical thrombectomy is a proposed strategy to improve outcomes of patients based on observational studies reporting worse functional outcomes with higher post-mechanical thrombectomy blood pressure. 2 Malhotra K Goyal N Katsanos AH et al. Association of blood pressure with outcomes in acute stroke thrombectomy. Hypertension. 2020; 75: 730-739 Crossref PubMed Scopus (70) Google Scholar , 3 Mistry EA Sucharew H Mistry AM et al. Blood pressure after endovascular therapy for ischemic stroke (BEST): a multicenter prospective cohort study. Stroke. 2019; 50: 3449-3455 Crossref PubMed Scopus (63) Google Scholar A previous randomised trial showed no improvement in the incidence of intracerebral haemorrhage after mechanical thrombectomy when a lower systolic blood pressure target was used; 4 Mazighi M Richard S Lapergue B et al. Safety and efficacy of intensive blood pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET): a multicentre, open-label, randomised controlled trial. Lancet Neurol. 2021; 20: 265-274 Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar however, the trial was underpowered to test superiority of this target for the improvement of functional outcomes. Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trialIntensive control of systolic blood pressure to lower than 120 mm Hg should be avoided to prevent compromising the functional recovery of patients who have received endovascular thrombectomy for acute ischaemic stroke due to intracranial large-vessel occlusion. Full-Text PDF