Biomaterial Database

Association of Contrast Enhancement After Reperfusion With Outcomes According to Blood Pressure Lowering in Patients With Acute Ischemic Stroke. 2022

Benjamin Maïer, and Ran Brauner, and Simon Escalard, and Benjamin Gory, and Bertrand Lapergue, and Igor Sibon, and Sebastien Richard, and Julien Labreuche, and Maeva Kyheng, and Jean-Philippe Desilles, and Raphael Blanc, and Michel Piotin, and Jean-Michel Halimi, and Mikael Mazighi, and

*These authors are co-first authors.

Observational studies described associations between higher systolic blood pressure (SBP) values and intracranial hemorrhages (ICHs) and worse outcomes after successful reperfusion by endovascular therapy (EVT). However, the BP-TARGET trial [BP-Target in Acute Ischemic Stroke to Reduce Hemorrhage after EVT] found that an intensive SBP target did not reduce ICH rates after successful EVT. The presence of contrast enhancement (CE) immediately after reperfusion is also associated with higher odds of ICH and worse outcomes. Our research question was to investigate the effect of 2 SBP strategies after reperfusion on ICH rates and functional outcomes according to the presence of CE in the BP-TARGET trial. We hypothesized that patients with CE could benefit from an intensive SBP control. We included BP-TARGET patients in whom a brain flat panel was performed immediately after reperfusion. We described CE as present or absent, ICH consisted of any radiographic ICH 24 hours after EVT, and unfavorable outcome consisted of a modified Rankin Scale score between 3 and 6 at 3 months. Among the 324 patients randomized in BP-TARGET, 164 were included in this analysis, of whom 113 (68.9%) presented CE after reperfusion. The 24-hour mean SBP was significantly lower in the intensive SBP group compared with the standard group (129.7 vs 138.3 mm Hg, p < 0.001). Patients with CE and randomized in the intensive and standard SBP group had increased ICH rates: aOR = 11.26, 95% CI 4.59-27.63, and aOR = 4.08, 95% CI 1.75-9.50, respectively. However, the test of heterogeneity did not reach the significant level (aOR = 2.76, 95% CI 0.80 to 9.48, p = 0.11). Patients with CE and randomized in the intensive SBP group had also higher odds of unfavorable outcomes (aOR = 2.91, 95% CI 1.24-6.82), but this association was not significant in the standard SBP group (aOR = 1.89, 95% CI 0.85-4.23). No significant heterogeneity was found between the 2 groups (aOR, 1.54, 95% CI 0.48 to 4.97, p = 0.47). Altogether, patients with CE and randomized in the intensive SBP group did not have lower rates of ICH or improved outcomes compared with the standard SBP group, as CE was associated with higher odds of ICH in both groups, without significant heterogeneity. NCT03160677. This study provides Class IV evidence that for adults with contrast-enhancing lesions after successful EVT of an AIS, intensive blood pressure management did not significantly increase the risk of ICH.

UI	MeSH Term	Description	Entries
D001794	Blood Pressure	PRESSURE of the BLOOD on the ARTERIES and other BLOOD VESSELS.	Systolic Pressure,Diastolic Pressure,Pulse Pressure,Pressure, Blood,Pressure, Diastolic,Pressure, Pulse,Pressure, Systolic,Pressures, Systolic
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000083242	Ischemic Stroke	Stroke due to BRAIN ISCHEMIA resulting in interruption or reduction of blood flow to a part of the brain. When obstruction is due to a BLOOD CLOT formed within in a cerebral blood vessel it is a thrombotic stroke. When obstruction is formed elsewhere and moved to block a cerebral blood vessel (see CEREBRAL EMBOLISM) it is referred to as embolic stroke. Wake-up stroke refers to ischemic stroke occurring during sleep while cryptogenic stroke refers to ischemic stroke of unknown origin.	Acute Ischemic Stroke,Cryptogenic Embolism Stroke,Cryptogenic Ischemic Stroke,Cryptogenic Stroke,Ischaemic Stroke,Wake-up Stroke,Acute Ischemic Strokes,Cryptogenic Embolism Strokes,Cryptogenic Ischemic Strokes,Cryptogenic Strokes,Embolism Stroke, Cryptogenic,Ischaemic Strokes,Ischemic Stroke, Acute,Ischemic Stroke, Cryptogenic,Ischemic Strokes,Stroke, Acute Ischemic,Stroke, Cryptogenic,Stroke, Cryptogenic Embolism,Stroke, Cryptogenic Ischemic,Stroke, Ischaemic,Stroke, Ischemic,Stroke, Wake-up,Wake up Stroke,Wake-up Strokes
D015424	Reperfusion	Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing REPERFUSION INJURY.	Reperfusions
D016896	Treatment Outcome	Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.	Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D020300	Intracranial Hemorrhages	Bleeding within the SKULL, including hemorrhages in the brain and the three membranes of MENINGES. The escape of blood often leads to the formation of HEMATOMA in the cranial epidural, subdural, and subarachnoid spaces.	Brain Hemorrhage,Hemorrhage, Intracranial,Posterior Fossa Hemorrhage,Brain Hemorrhages,Hemorrhage, Brain,Hemorrhage, Posterior Fossa,Hemorrhages, Brain,Hemorrhages, Intracranial,Hemorrhages, Posterior Fossa,Intracranial Hemorrhage,Posterior Fossa Hemorrhages