Blood Pressure Target in Acute Stroke to Reduce HemorrhaGe After Endovascular Therapy: The Randomized BP TARGET Study Protocol

Mazighi, Mikaël; Labreuche, Julien; Richard, Sébastien; Gory, Benjamin; Lapergue, Bertrand; Sibon, Igor; Berge, Jérôme; Olivot, Jean‐Marc; Reiner, Peggy; Houdart, Emmanuel; Broderick, Joseph P.; Duhammel, Alain; Maïer, Benjamin; Yavchitz, Amélie; Salomon, Laurence; Obadia, Michaël; Blanc, Raphaël; Savatovsky, Julien; Piotin, Michel

doi:10.3389/fneur.2020.00480

Cited by 16 publications

(19 citation statements)

References 33 publications

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“… 22 Therefore, further randomized trials are imperative and urgently needed to determine whether the observed associations in the current study are causative and modifiable. 23 …”

Section: Discussionmentioning

confidence: 99%

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status

Huang

Guo

Yuan

et al. 2021

Ther Adv Neurol Disord

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Background: Blood pressure (BP), recanalization status, and collateral circulation are important factors for cerebral autoregulation after stroke. We aimed to investigate the association of various BP variability (BPV) parameters with clinical outcomes after mechanical thrombectomy (MT) according to recanalization and collateral status. Methods: We included 502 consecutive patients who underwent MT due to anterior circulation large vessel occlusion stroke at three comprehensive stroke centers. BPV parameters were standard deviation (SD), maximum/minimum BP, coefficient of variation (CV) and successive variation (SV). The clinical outcomes included 90-day functional outcome assessed by modified Rankin Scale score and symptomatic intracranial hemorrhage (sICH). Results: Among the included patients, 219 (43.6%) achieved good functional outcomes and 59 (11.8%) developed sICH. After adjusting for confounders, higher systolic BP (SBP) variability [CV (odds ratio (OR), 1.089, p = 0.035), SV (OR, 1.082, p = 0.004). and SD (OR, 1.074, p = 0.027)] was associated with a lower likelihood of a favorable outcome. In addition, higher SBP [CV (OR, 1.156, p = 0.001) and SD (OR, 1.118, p = 0.001)] were significantly associated with increased odds of sICH. Moreover, the relationship between BPV and the outcomes depended on recanalization status. However, regardless of collateral status, a higher BPV after MT was associated with worse outcomes. Conclusions: Higher SBP SD and CV during the first 24 h after MT was a powerful predictor of worse clinical outcomes, regardless of the collateral status. However, the effects of BPV on outcomes were more substantial among patients with successful reperfusion.

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“… 22 Therefore, further randomized trials are imperative and urgently needed to determine whether the observed associations in the current study are causative and modifiable. 23 …”

Section: Discussionmentioning

confidence: 99%

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status

Huang

Guo

Yuan

et al. 2021

Ther Adv Neurol Disord

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“…[109][110][111][112] The only completed RCT is the Blood Pressure Target in Acute Stroke to Reduce Haemorrhage After Endovascular Therapy (BP-TARGET) trial, a multicentre, prospective, randomised, controlled, open-label, blinded endpoint clinical trial conducted in France. 113,114 The study enrolled AIS patients with large vessel occlusion in the anterior circulation who had successful reperfusion (defined as modified Thrombolysis In Cerebral Infarction (mTICI) grades of 2 b or 3) following MT. The enrolled patients were randomly assigned, in a 1:1 ratio, to have intensive (systolic blood pressure target 100-129 mm Hg) or a conservative (systolic blood pressure target 130-185 mm Hg) blood pressure control in the following 24 hours, with the primary efficacy endpoint of radiographic intraparenchymal haemorrhage at 24-36 hours and the primary safety endpoint of hypotension occurrence.…”

Section: Analysis Of Current Evidencementioning

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

114

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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“…The trial was negative for the primary outcome, which was the reduction of disability at 3 months, assessed by mRS scale ( 137 ). On the other hand, the intervention group had a significant reduction in the secondary outcome: “any intracranial hemorrhage.” An ongoing RCT ( 138 ) will demonstrate if aggressive reduction of BP (<140/90 mmHg) is effective after MT in reducing risk of intracranial hemorrhage. A recent review described hemodynamic parameters following recanalization and pointed out the fact that BP targets may be dependent on individual parameters such as autoregulatory limits and BP trajectories.…”

Section: Future Directionsmentioning

confidence: 99%

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

et al. 2021

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Intracranial hemorrhage is one of the most feared complications following brain infarct. Ischemic tissues have a natural tendency to bleed. Moreover, the first recanalization trials using intravenous thrombolysis have shown an increase in mild to severe intracranial hemorrhage. Symptomatic intracerebral hemorrhage is strongly associated with poor outcomes and is an important factor in recanalization decisions. Stroke physicians have to weigh the potential benefit of recanalization therapies, first, with different risks of intracranial hemorrhage described in randomized controlled trials, and second with numerous risk markers that have been found to be associated with intracranial hemorrhage in retrospective series. These decisions have become quite complex with different intravenous thrombolytics and mechanical thrombectomy. This review aims to outline some elements of the pathophysiological mechanisms and classifications, describe most of the risk factors identified for each reperfusion therapy, and finally suggest future research directions that could help physicians dealing with these complications.

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Blood Pressure Target in Acute Stroke to Reduce HemorrhaGe After Endovascular Therapy: The Randomized BP TARGET Study Protocol

Abstract: Conclusion: This is the first randomized trial directly comparing the efficacy of different SBP targets after EVT reperfusion. This prospective trial aims to determine whether a "tight" SBP control after EVT reperfusion can reduce the risk of ICH.

Cited by 16 publications

References 33 publications

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status

Blood pressure variability and outcomes after mechanical thrombectomy based on the recanalization and collateral status

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

Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke

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