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Publications

Journal Article Ahead of print

PubMed: 42258192 DOI: 10.1001/jamaneurol.2026.1706

Personalized Blood Pressure Targeting After Endovascular Therapy for Acute Ischemic Stroke: A Randomized Clinical Trial.

JAMA Neurol

Authors: Pol Camps-Renom, Marina Guasch-Jiménez, Juan Álvarez-Cienfuegos, Nicolás López-Hernández, Ana Rodríguez-Campello, Herbert Tejada-Meza, Luis López-Mesonero, Laura Albert-Lacal, Mari Mar Freijo-Guerrero, Diana Tarruella-Hernández, Alan Flores, Juan Antonio Cabezas-Rodríguez, Joan Miquel Fernández-Vidal, Alejandro Martínez-Domeño, Natalia Pérez de la Ossa, Anna Ramos-Pachón, Ana Aguilera-Simón, Rebeca Marín, Garbiñe Ezcurra-Díaz, Álvaro Lambea-Gil, Yolanda Silva, Diego José Corona-García, Eva Giralt-Steinhauer, Javier Marta-Moreno, Jesús Alberto Vizcaya-Gaona, Ainara Sanz-Monllor, Alain Luna, Mikahela López Morales, Xavier Ustrell, Francisco Moniche, Judit Solà-Roca, Xia Wang, Craig S Anderson, Luis Prats-Sánchez, Joan Martí-Fàbregas

Affiliations

  • Stroke Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain.
  • Stroke Unit, Department of Neurology, Hospital Dr Josep Trueta, Girona, Spain.
  • Neurology Department, Dr Balmis General University Hospital, Alicante Institute for Health and Biomedical Research, Alicante, Spain.
  • Stroke Unit, Department of Neurology, Hospital del Mar, Neurovascular Research Group, Hospital del Mar Research Institute, Barcelona, Spain.
  • Stroke Unit, Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
  • Grupo de Investigación en Neurociencias, Instituto de Investigación Sanitaria Aragón, Zaragoza, Spain.
  • Interventional Neuroradiology Unit, Department of Radiology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
  • Stroke Unit, Department of Neurology, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
  • Stroke Unit, Department of Neurology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria Pascual Parrilla, Murcia, Spain.
  • Biobizkaia Health Research Institute, Grupo Neurovascular, Servicio Neurología, Hospital Universitario Cruces, Barakaldo, Spain.
  • Stroke Unit, Hospital Universitario La Fe, Valencia, Spain.
  • Stroke Unit, Department of Neurology, Hospital Universitari de Tarragona Joan XXIII, Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain.
  • Department of Neurology, Stroke Unit, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen Del Rocío, Consejo Superior de Investigaciones Científicas, Universidad de Sevilla, Seville, Spain.
  • Servei d'Epidemiologia Clínica i Salut Pública, Institut de Recerca Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
  • The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
  • Institute for Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China.
  • Neurology Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.

Abstract

IMPORTANCE

Optimal blood pressure (BP) management after successful endovascular therapy for acute ischemic stroke remains uncertain, as intensive lowering has shown no benefit or potential harm in prior trials.

OBJECTIVE

To determine whether a reperfusion-guided systolic BP control strategy improves functional outcomes compared with guideline-recommended management after successful endovascular therapy for acute ischemic stroke.

DESIGN, SETTING, AND PARTICIPANTS

This investigator-initiated, multicenter, prospective, randomized, open-label clinical trial with blinded end point assessment was conducted among adults with acute ischemic stroke due to anterior circulation large-vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction [mTICI] score ≥2b) after endovascular therapy at 11 comprehensive stroke centers in Spain between June 14, 2021, and October 1, 2025, with 90-day follow-up. Data analysis was conducted from February 1 to March 12, 2026.

INTERVENTIONS

Participants were randomly assigned (1:1) to a reperfusion-guided systolic BP strategy (140-160 mm Hg for mTICI score of 2b; 100-140 mm Hg for mTICI score of 2c/3) or guideline-recommended management (systolic BP <180 mm Hg) for 72 hours using antihypertensive agents or vasopressors as needed.

MAIN OUTCOMES AND MEASURES

The primary outcome was a favorable functional outcome, defined as a modified Rankin Scale score of 0 to 2 at 90 days, assessed in the intention-to-treat population. Of 446 enrolled patients, 440 were included in the intention-to-treat analysis (mean age, 75 years; 53% women); 6 were excluded due to withdrawal or consent withdrawal.

RESULTS

Among 440 patients (mean [SD] age, 75 [12] years; 233 [53.0%] women), 215 were assigned to the intervention group and 225 to the control group. At 90 days, 129 patients (60.0%) in the intervention group and 106 (47.1%) in the control group achieved a favorable functional outcome (absolute risk difference, 13.3%; 95% CI, 4.1%-22.6%; P = .005). Hemorrhagic transformation occurred in 48 patients (22.3%) in the intervention group and 71 (31.6%) in the control group (odds ratio, 0.62; 95% CI, 0.41-0.95). The rates of symptomatic intracranial hemorrhage (3.5% vs 3.9%) and 90-day mortality (15.4% vs 15.6%) did not differ between groups. Serious adverse events occurred in 34 patients (15.8%) in the intervention group and 27 (12.0%) in the control group.

CONCLUSIONS AND RELEVANCE

In this randomized clinical trial, a reperfusion-guided BP strategy improved functional outcomes and reduced hemorrhagic transformation without increasing major safety events, supporting a tailored approach to postthrombectomy BP management.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04892511.

MeSH

Blood, Ischemic Stroke, Stroke, Blood Pressure, Antihypertensive Agents, Reperfusion, Therapeutics, Nervous System Diseases