Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial

Pengfei, Yang; Song, Lili; Zhang, Yongwei; Zhang, Xiaoxi; Chen, Xiaoying; Li, Yunke; Sun, Lingli; Wan, Yingfeng; Billot, Laurent; Ren, Xinwen; Shen, Hongjian; Zhang, Lei; Li, Zifu; Pengfei, Xing; Zhang, Yongxin; Zhang, Ping; Weilong, Hua; Shen, Fang; Yihan, Zhou; Tian, Bing; Chen, Wenhuo; Han, Hongxing; Zhang, Liyong; Xu, Chenghua; Li, Tong; Peng, Ya; Yue, Xincan; Chen, Shengli; Wen, Changming; Wan, Shu; Chen, Yin; Wei, Ming; Shu, Hansheng; Guo, Nan; Liu, Sheng; Liu, Wenhua; Cai, Yuyang; Sui, Yi; Chen, Maohua; Zhou, Yu; Zuo, Qiao; Dai, Dongwei; Zhao, Rui; Li, Qiang; Huang, Qinghai; Xu, Yi; Deng, Bo; Wu, Tao; Lu, Jianping; Wang, Xia; Parsons, Mark; Butcher, Ken; Campbell, Bruce; Robinson, Thompson; Goyal, Mayank; Dippel, Diederik W.J.; Roos, Yvo B.W.E.M.; Majoie, Charles; Wang, Longde; Wang, Yongjun; Liu, Jianmin; Anderson, Craig S.

doi:10.1016/s0140-6736(22)01882-7

Cited by 112 publications

(132 citation statements)

References 30 publications

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“… 25 The BP-TARGET trial 3 result of a systolic target of 100–129 mmHg being safe after successful endovascular thrombectomy has been called into question following the early stopping of the ENCHANTED2/MT trial due to clearly identified harms. 4 More intensive blood pressure lowering is likely to have an adverse effect on blood flow within the cerebral microcirculation. The results of brain imaging from ENCHANTED2/MT and pooling of data between these and other trials are eagerly awaited.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, we have been unable to provide recommendations over the optimal levels of blood pressure control in specific patient groups with acute ischaemic stroke. Further analysis of ENCHANTED2/MT, 4 and results of similar trials in patient who have received endovascular therapy and that of the ongoing Intensive Ambulance-delivered Blood Pressure Reduction in Hyper-Acute Stroke Trial (INTERACT4) 29 due in 2024, are expected to provide further insights into the effects of early intensive blood pressure lowering in different patient groups and clinical settings.…”

Section: Discussionmentioning

confidence: 99%

“…The 2021 Blood Pressure Target in Acute Stroke to Reduce hemorrhaGe After Endovascular Therapy (BP-TARGET) trial 3 showed that more intensive systolic blood pressure control (mean achieved in 24 h, 128 mm Hg) versus standard systolic blood pressure control (mean achieved in 24 h, 138 mm Hg) was safe but without showing any improvement in clinical outcomes in 324 patients after successful endovascular thrombectomy for acute ischaemic stroke from large-vessel occlusion of the anterior circulation. More recently, however, the Enhanced Control of Hypertension and Thrombectomy Stroke Study (ENCHANTED2/MT) 4 showed that intensive control of systolic blood pressure to lower than 120 mm Hg resulted in worse functional recovery in 816 patients who received endovascular thrombectomy for acute ischaemic stroke from any intracranial large-vessel occlusion. Herein, we present further analyses of the ENCHANTED ‘blood pressure control’ arm of the effects of intensive blood pressure lowering on the size of cerebral infarction identified on brain imaging obtained during the follow-up of participants as part of their routine standard of care.…”

Section: Introductionmentioning

confidence: 99%

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Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial

Chen¹,

Ouyang²,

Ong³

et al. 2023

eClinicalMedicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial

Chen¹,

Ouyang²,

Ong³

et al. 2023

eClinicalMedicine

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“…A score of 2-5 indicates some degree of disability. (22) We obtained the summary-level data for functional outcome after ischemic stroke from the Genetics of Ischemic Stroke Functional Outcome (GISCOME) network meta-analysis, which contains 12 studies with 6,021 stroke patients from the US, Europe, and Australia. (23) In the primary analysis, we used the summary data which was adjusted for age, sex, principal components, and baseline NIHSS score.…”

Section: Outcome Datamentioning

confidence: 99%

Genetically Determined Blood Pressure, Antihypertensive Drugs, and Genes with Clinical Outcome after Ischemic Stroke: Evidence from Mendelian Randomization

Liu

Zhang

Zhou

et al. 2023

Preprint

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Background: Observational studies suggest a robust association between blood pressure (BP) and functional outcomes in ischemic stroke patients. We sought to identify novel associations of the genetic basis of 3-month functional outcome after ischemic stroke based on a Mendelian randomization (MR) framework.<break><break>Methods: We selected genetic variants associated with systolic and diastolic BP and BP-lowering variants in genes encoding antihypertensive drugs from genome-wide association studies (GWAS) on 757,601 individuals. The primary outcome was 3-month favorable functional outcome defined as modified Rankin Scale (mRS) of 0-2. The secondary outcome was excellent 90-day outcome defined as mRS 0-1. The Cochrans Q statistic in Inverse variance weighted (IVW) model, the weighted median, MR-Egger regression, leave-one-SNP-out analysis, MR-Pleiotropy Residual Sum and Outlier methods were adopted as sensitivity analyses. To validate our primary results, we performed independent repeat analyses and Bi-directional MR analyses.<break><break>Results: Genetic predisposition to higher systolic and diastolic BP was associated with a lower probability of 3-month excellent functional outcome after ischemic stroke in univariable IVW MR analysis (OR=1.29, 95%CI 1.05-1.59, p=0.014; OR=1.27, 95%CI 1.07-1.51, p=0.006, respectively). Pulse pressure was associated with both excellent and favorable functional outcome (OR=1.05, 95%CI 1.02-1.08, p=0.002; OR=1.04, 95%CI 1.01-1.07, p=0.009, respectively). Angiotensin-converting enzyme inhibitor (ACEI) and calcium channel blocker (CCB), were significantly associated with improved favorable functional outcome (OR=0.76, 95%CI 0.62-0.94, p=0.009; OR=0.89, 95%CI 0.83-0.97, p=0.005). Proxies for -blockers, angiotensin receptor blocker (ARB) and thiazides failed to show associations with functional outcome (p>0.05). <break><break>Conclusion: We provide evidence for a potential association of genetic predisposition to higher BP with higher risk of 3-month functional dependence after ischemic stroke. Our findings support ACEI and CCB as promising antihypertensive drugs for improving functional outcome in ischemic stroke.

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“…In recent years, BP-TARGET study [14] evaluated AIS patients treated with MT and found that the standard antihypertensive treatment group (SBP maintained at 130-185 mmHg) compared with the potent antihypertensive treatment group (100-129 mmHg) was not effective in reducing the rate of parenchymal hemorrhage at 24-36 h after therapy. The ENCHANTED2/MT multicenter clinical study [15] showed that for AIS patients with successful postoperative reperfusion (extended thrombolysis in cerebral infarction (eTICI) 2b/2c/3), intensive postoperative hypotensive treatment (SBP < 120 mmHg) may lead to the decreased functional prognosis (modi ed Rankin scale (mRS) score, 0-2 points) at 90 days and may result in early neurological deterioration and higher 90-day disability rates compared with the standard hypotensive group (140-180 mmHg). However, the two groups had no signi cant difference in the rate of symptomatic hemorrhagic transformation.…”

mentioning

confidence: 99%

Blood pressure management strategy in patients with acute ischemic stroke after mechanical thrombectomy (CHASE-MT): A prospective, multicenter, randomized controlled, open-label clinical trial protocol

Zhao

Guo

Shi

et al. 2023

Preprint

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Background The efficient control of blood pressure (BP) after mechanical thrombectomy (MT) has not been determined, and there is a lack of multicenter, prospective, randomized controlled, open-label clinical studies on the precise management of BP in patients with acute ischemic stroke (AIS) after undergoing MT. This trial aims to determine whether potent antihypertensive therapy (90–110 mmHg) effectively reduces the incidence of symptomatic hemorrhagic transformation at 48 h after MT and the incidence of poor prognosis at 90 days after therapy in patients with AIS. Methodology/Design: This is a randomized, controlled, open-label, prospective, multicenter clinical trial. Patients with AIS treated with MT will be screened. A total of 324 adult patients with AIS (National Institutes of Health Stroke Scale (NIHSS) score, 6–19 points) will be recruited from 11 sites located in Shaanxi and Gansu pration system. The primary outcome measure is the proportion of patients in the trial group with a good prognosis (modified Rankin scale (mRS) score ≤ 2 points) at 90 days after treatment compared with the control group. The secondary outcome measures are the incidence of sICH due to reperfusion injury within 48 h after therapy, NIHSS score at 48 h after therapy, and mRS score at 14 days after therapy in both groups. Demographic characteristics, relevant medical history, characteristics of the occluded vessels, perioperative treatment, and monitoring results will be collected from all study subjects. The relationship between BP levels in AIS patients at 48 after successful recanalization and symptomatic hemorrhagic transformation and clinical prognosis will be explored. Discussion The CHASE-MT trial will be a large multicenter study that actively explores BP management strategies in patients with AIS undergoing MT. This trial has the potential to address the persistent BP elevation or high postoperative BP variability after successful recanalization in patients with AIS and to provide optimal BP levels. Trial registration: This trial was registered at ClinicalTrials.gov (Identifier: NCT05282290, Date of registration: June 13, 2022).

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Intensive blood pressure control after endovascular thrombectomy for acute ischaemic stroke (ENCHANTED2/MT): a multicentre, open-label, blinded-endpoint, randomised controlled trial

Cited by 112 publications

References 30 publications

Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial

Effects of intensive blood pressure lowering on cerebral ischaemia in thrombolysed patients: insights from the ENCHANTED trial

Genetically Determined Blood Pressure, Antihypertensive Drugs, and Genes with Clinical Outcome after Ischemic Stroke: Evidence from Mendelian Randomization

Blood pressure management strategy in patients with acute ischemic stroke after mechanical thrombectomy (CHASE-MT): A prospective, multicenter, randomized controlled, open-label clinical trial protocol

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