A pilot randomised controlled trial of the management of systolic blood pressure during endovascular thrombectomy for acute ischaemic stroke

Deng, Carolyn; Campbell, Douglas; Diprose, William K; Eom, Cheol; Wang, K.; Robertson, N.; Short, Timothy G.; Brew, Stefan; Caldwell, James R.; McGuinness, Ben; Barber, P. Alan

doi:10.1111/anae.14940

Cited by 19 publications

(24 citation statements)

References 31 publications

(46 reference statements)

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“…This trial randomly assigned 51 patients to receive either standard or augmented systolic blood pressure management from the start of anaesthesia to recanalisation of the target vessel. 106 There were no safety concerns with trial procedures and all feasibility targets were achieved.…”

Section: In Patients With Acute Ischaemic Stroke Caused By Large Vessel Occlusion and Undergoing Mechanical Thrombectomy (With Or Withoutmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage

Sandset

Anderson

Bath

et al. 2021

European Stroke Journal

115

100

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The optimal blood pressure (BP) management in acute ischaemic stroke (AIS) and acute intracerebral haemorrhage (ICH) remains controversial. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist physicians in their clinical decisions regarding BP management in acute stroke. The guidelines were developed according to the ESO standard operating procedure and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The working group identified relevant clinical questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and made specific recommendations. Expert consensus statements were provided where insufficient evidence was available to provide recommendations based on the GRADE approach. Despite several large randomised-controlled clinical trials, quality of evidence is generally low due to inconsistent results of the effect of blood pressure lowering in AIS. We recommend early and modest blood pressure control (avoiding blood pressure levels >180/105 mm Hg) in AIS patients undergoing reperfusion therapies. There is more high-quality randomised evidence for BP lowering in acute ICH, where intensive blood pressure lowering is recommended rapidly after hospital presentation with the intent to improve recovery by reducing haematoma expansion. These guidelines provide further recommendations on blood pressure thresholds and for specific patient subgroups. There is ongoing uncertainty regarding the most appropriate blood pressure management in AIS and ICH. Future randomised-controlled clinical trials are needed to inform decision making on thresholds, timing and strategy of blood pressure lowering in different acute stroke patient subgroups.

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Section: In Patients With Acute Ischaemic Stroke Caused By Large Vessel Occlusion and Undergoing Mechanical Thrombectomy (With Or Withoutmentioning

confidence: 99%

European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage

Sandset

Anderson

Bath

et al. 2021

European Stroke Journal

115

100

View full text Add to dashboard Cite

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“…The currently ongoing MAS-TERSTROKE study, assesing two hemodynamic targets during EVT from the beginning of anesthesia to the moment of recanalisation, might provide an interesting perspective. The pilot trial showed no differences in early neurological improvement, all-cause mortality at 90 days, intraoperative complications or intracerebral haemorrhage rates between patients in two BP target groups (130-150 mmHg and 160-180 mmHg) [54].…”

Section: Type Of Reperfusion Therapymentioning

confidence: 87%

Ambiguities in blood pressure management in acute ischaemic stroke

Kamieniarz-Mędrygał¹,

Kaźmierski

2022

Neurol Neurochir Pol.

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Introduction: Blood pressure management in acute ischaemic stroke is crucial. Here we highlight uncertainties surrounding haemodynamic management in acute ischaemic stroke on the basis of current guidelines and the data available from recent studies. This review provides practical treatment options and suggestions for future research. State of the art:The U-shaped relationship between baseline blood pressure value and patients' functional outcome or death is well established. Nonetheless, there is scant evidence for the benefits of early pharmacological intervention. Current guidelines differentiate blood pressure targets on the basis of implemented reperfusion treatment and allow blood pressure reduction in certain clinical situations. However, there is a substantial lack of evidence to guide management during acute stroke. Clinical implications:Taking into account several aspects of blood pressure management can improve stroke care, although they are not included in current guidelines. To make an optimal decision as to whether to intervene regarding blood pressure, it is important to consider dehydration, recanalisation status, blood pressure variability, and autoregulation state as measured by novel imaging techniques.Future directions: Further trials considering patient-specific factors with the use of continuous monitoring of blood pressure, as well as neurovascular imaging, are needed to resolve the current ambiguities.

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“…In light of the shortcomings of previous work, the study published in this month's issue of Anaesthesia by Deng et al. is an important first step in refining intra‐operative thrombectomy practice. The authors conducted a pilot study to assess the feasibility of a future larger randomised controlled trial.…”

Section: Advantages and Disadvantages Of General Anaesthesia (Includimentioning

confidence: 99%

Is blood pressure maintenance more important than type of anaesthesia for patients undergoing mechanical thrombectomy after ischaemic stoke?

Wiles

2020

Anaesthesia

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A pilot randomised controlled trial of the management of systolic blood pressure during endovascular thrombectomy for acute ischaemic stroke

Cited by 19 publications

References 31 publications

European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage

European Stroke Organisation (ESO) guidelines on blood pressure management in acute ischaemic stroke and intracerebral haemorrhage

Ambiguities in blood pressure management in acute ischaemic stroke

Is blood pressure maintenance more important than type of anaesthesia for patients undergoing mechanical thrombectomy after ischaemic stoke?

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