SynthesisThe Lancet. Neurology2023
Admission systolic blood pressure and effect of endovascular treatment in patients with ischaemic stroke: an individual patient data meta-analysis.
Synthesis in The Lancet. Neurology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Blood pressure targets after successful reperfusion in mechanical thrombectomy for acute ischemic stroke: an updated systematic review and meta-analysis of randomized clinical trials.Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2024Pooled it
- Systolic blood pressure within 24 hours after successful reperfusion correlates with outcomes in acute ischemic stroke: a secondary analysis of the EHCHANTED2/MT Trial.Journal of neurointerventional surgery · 2026Trial
- Associations Between Gene Variants of Lipid-Lowering Drug Targets and Adverse Outcomes After Ischemic Stroke.Journal of the American Heart Association · 2024Trial
- Trial
- Blood pressure management for stroke patients beyond the JSH 2025 guidelines.Hypertension research : official journal of the Japanese Society of Hypertension · 2026Review
- Prognostic Modeling Based on Post-Endovascular Thrombectomy Systolic Blood Pressure Trajectories Using Explainable Artificial Intelligence: A Secondary Analysis of the OPTIMAL-BP Trial.Journal of medical systems · 2026Observational
- Admission Systolic Blood Pressure and Outcomes After Endovascular Thrombectomy: An International EVA-TRISP Cohort Study.Neurology · 2026Observational
- Intensive versus standard blood pressure management after endovascular therapy in acute ischemic stroke: a systematic review and meta-analysis.Annals of medicine and surgery (2012) · 2026Article
- Associations of Serum Complement Biomarkers With Adverse Clinical Outcomes Among Patients With Ischemic Stroke.Journal of the American Heart Association · 2026Article
- Association Between Hyperacute Blood Pressure Lowering and Outcomes in Patients With Endovascular Thrombectomy.Journal of stroke · 2026Article
- Blood pressure variation and futile recanalisation in patients with large-vessel occlusion after endovascular therapy.BMJ neurology open · 2026Article
- Endovascular thrombectomy for acute ischemic stroke: evolving patient selection, procedural strategies, and adjunctive therapies.Frontiers in neurology · 2026Review
- Pulse pressure after thrombectomy predicts functional outcomes and mortality in acute ischemic stroke with large artery occlusion.Scientific reports · 2025Article
- Blood Pressure Management Pre- and Post-Reperfusion in Acute Ischemic Stroke: Evidence and Insights from Recent Studies.Current neurology and neuroscience reports · 2025Review
- Predictive Modeling of Heterogeneous Treatment Effects in RCTs: A Scoping Review.JAMA network open · 2025Article
- Interaction of brain imaging features and effects of intensive blood pressure lowering after endovascular treatment for acute ischaemic stroke: the pre-specified secondary analyses of ENCHANTED2/MT trial.EClinicalMedicine · 2025Article
- Potential clinical impact of predictive modeling of heterogeneous treatment effects: scoping review of the impact of the PATH Statement.medRxiv : the preprint server for health sciences · 2025Article
- Predicting 28-day mortality for patients with acute anterior circulation large vessel occlusion stroke following endovascular treatment in neurology intensive care units.Frontiers in neurology · 2025Article
- Lack of Consensus among Stroke Experts on the Optimal Blood Pressure Target of Acute Ischemic Stroke: Evidence from a National Survey.Cerebrovascular diseases (Basel, Switzerland) · 2025Article
- Communicating Arteries and Leptomeningeal Collaterals: A Synergistic but Independent Effect on Patient Outcomes after Stroke.Neurology international · 2024Article
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Authors and funding
24 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCurrent guidelines for ischaemic stroke treatment recommend a strict, but arbitrary, upper threshold of 185/110 mm Hg for blood pressure before endovascular thrombectomy. Nevertheless, whether admission blood pressure influences the effect of endovascular thrombectomy on outcome remains unknown. Our aim was to study the influence of admission systolic blood pressure (SBP) on functional outcome and on the effect of endovascular thrombectomy.
methodsWe used individual patient data from seven randomised controlled trials (MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, REVASCAT, PISTE, and THRACE) that randomly assigned patients with anterior circulation ischaemic stroke to endovascular thrombectomy (predominantly using stent retrievers) or standard medical therapy (control) between June 1, 2010, and April 30, 2015. We included all patients for whom SBP data were available at hospital admission. The primary outcome was functional outcome (modified Rankin Scale) at 90 days. We assessed the association of SBP with outcome in both the endovascular thrombectomy group and the control group using multilevel regression analysis and tested for non-linearity and for interaction between SBP and effect of endovascular thrombectomy, taking into account treatment with intravenous thrombolysis.
findingsWe included 1753 patients (867 assigned to endovascular thrombectomy, 886 assigned to control) after excluding 11 patients for whom SBP data were missing. We found a non-linear association between SBP and functional outcome with an inflection point at 140 mm Hg (732 [42%] of 1753 patients had SBP <140 mm Hg and 1021 [58%] had SBP ≥140 mm Hg). Among patients with SBP of 140 mm Hg or higher, admission SBP was associated with worse functional outcome (adjusted common odds ratio [acOR] 0·86 per 10 mm Hg SBP increase; 95% CI 0·81-0·91). We found no association between SBP and functional outcome in patients with SBP less than 140 mm Hg (acOR 0·97 per 10 mm Hg SBP decrease, 95% CI 0·88-1·05). There was no significant interaction between SBP and effect of endovascular thrombectomy on functional outcome (p=0·96).
interpretationIn our meta-analysis, high admission SBP was associated with worse functional outcome after stroke, but SBP did not seem to negate the effect of endovascular thrombectomy. This finding suggests that admission SBP should not form the basis for decisions to withhold or delay endovascular thrombectomy for ischaemic stroke, but randomised trials are needed to further investigate this possibility.
fundingMedtronic.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.