[en] Background and Purpose: Optimal blood pressure (BP) targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) still need to be assessed, especially according to the recanalization status. Facing the lack of randomized controlled trials addressing this question, we performed a systematic review of studies assessing the post-EVT BP impact on functional outcome and symptomatic intracranial hemorrhage (sICH). Methods: Studies published after January 1, 2012 were included in the systematic review. The PRISMA checklist and flow diagram were followed for the design and reporting of this work. Results: Five studies were included in the present analysis. Despite a significant heterogeneity among studies which precluded a meta-analysis, systolic BP (SBP) was the most frequently used parameter to describe BP. BP variability (standard deviation, successive variability) after EVT was associated with worse functional outcome, especially in studies without specific BP targets after successful EVT. Lower BP values after successful EVT were associated with lower odds of sICH. Four studies evaluated the post-EVT BP impact on recanalized patients solely, with only one specifically addressing the impact of a TICI 2B vs. 2C. Interestingly, SBP reduction was inversely associated with worse outcomes in TICI 3 patients but not in TICI 2B patients, pointing to the potential value of BP management according to the exact TICI. Conclusions: BP post-EVT seems to be associated with worse functional outcomes and sICH. However, given the important heterogeneity depicted among the included studies, no decisive conclusion can be made from this systematic review, thus underlying the urgent need of randomized controlled trials evaluating this question.
Disciplines :
Neurology
Author, co-author :
Maïer, Benjamin; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France ; Université de Paris, Paris, France
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques ; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
Labreuche, Julien; University Lille, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
Escalard, Simon; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
Desilles, Jean-Philippe; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France ; Université de Paris, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Redjem, Hocine; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
Hébert, Solène; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
Smajda, Stanislas; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
Ciccio, Gabriele; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France
Lapergue, Bertrand; Stroke Center, Foch Hospital, Suresnes, France
Blanc, Raphaël; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Piotin, Michel; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France
Mazighi, Mikael; Interventional Neuroradiology Department, Fondation Rothschild, Paris, France ; Université de Paris, Paris, France ; Laboratory of Vascular Translational Science, INSERM U1148, Paris, France ; FHU Neurovasc, Paris, France
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