M Rafiqul Islam: Post-Thrombectomy Blood Pressure Management in Acute Ischemic Stroke
M Rafiqul Islam, Physician at Bangladesh College of Physicians and Surgeons (BCPS), shared a post on LinkedIn about a recent article he and his colleagues co-authored, adding:
“New Publication Alert!
Our meta-analysis is now live in Stroke: Vascular and Interventional Neurology! (AHA Journal)
Intensive versus Standard Blood Pressure Targets After Successful Endovascular Thrombectomy.
Does Lowering BP More Actually Help?
We set out to answer one of the most debated questions in post-EVT care: should we aggressively lower systolic BP after successful thrombectomy, or is a permissive standard approach better?
After synthesizing data from 6 RCTs and 1,972 patients using both frequentist and Bayesian meta-analysis frameworks, here is what we found:
- Intensive SBP control (less than 140 mmHg) was associated with a significantly lower likelihood of functional independence at 90 days (RR 0.83, 95 percent CI 0.73–0.93) — a finding confirmed by Bayesian analysis with only a 3.2 percent posterior probability of benefit.
- Ordinal mRS shift analysis showed a significant push toward worse functional outcomes across the entire mRS spectrum (OR 1.26).
No significant reduction in intracranial hemorrhage risk was found — meaning the rationale for aggressive BP lowering post-EVT is not supported by the data.
Trial sequential analysis confirmed the cumulative evidence has crossed the harm boundary — further similar trials are unlikely to change this conclusion.
Bottom line:
A standard, guideline-based SBP target of less than 180 mmHg should remain the default after successful EVT.
Intensive lowering appears to do more harm than good — likely by compromising perfusion in a reperfused brain with impaired autoregulation.
This work reinforces current AHA/ASA and ESO guidelines while providing the strongest probabilistic evidence to date against routine intensive BP lowering post-EVT.
Huge congratulations to all co-authors on this collaborative effort!
As a group lead Ahmed Ibrahim bro showed his excellent effort throughout the process.”
Title: Intensive Versus Standard Systolic Blood Pressure Targets Following Successful Endovascular Thrombectomy for Acute Ischemic Stroke: A Systematic Review With Frequentist and Bayesian Meta-Analysis
Authors: Ahmed Ibrahim, AlMothana Manasrah, M Rafiqul Islam, Ibrahim Khalil, Ali Saad Al-Shammari, Sohaila Mourad, Elsayed Balbaa, Hossam Elbenawi, Yasar Sattar, Aristeidis H. Katsanos, Giuseppe Andò
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