Systolic blood pressure within 24 hours after successful reperfusion correlates with outcomes in acute ischemic stroke: a secondary analysis of the EHCHANTED2/MT Trial

Clinical Snapshot

Key Findings

• P Value: p=0.013 for primary outcome

• Effect Size: Adjusted OR 1.54 for better functional outcomes with lower BP target

• Primary Outcome: Better functional outcomes (mRS) in 120-140 mmHg group: median mRS 2 (IQR 1-4) vs 2 (IQR 1-5)

• Nnt Or Sensitivity: Mortality reduction: 13.0% vs 21.4% (absolute risk reduction 8.4%, NNT approximately 12)

• Confidence Interval: 95% CI 1.10 to 2.17

Clinical Application

Feasible in Australian stroke centres with established thrombectomy services and intensive monitoring capabilities Aligns with current Australian stroke guidelines emphasizing post-thrombectomy care. Relevant for comprehensive stroke centres with 24/7 monitoring capacity. May inform local BP management protocols post-EVT. Acute ischemic stroke patients who achieve successful reperfusion (TICI 2b-3) after endovascular thrombectomy

Abstract

BACKGROUND: The optimal threshold or range for systolic blood pressure (SBP) control in patients with successful reperfusion after endovascular thrombectomy for acute ischemic stroke (AIS) remains undefined. This study investigated whether SBP within the first 24 hours after successful reperfusion correlates with functional outcomes in AIS. METHODS: In this secondary analysis of the ENCHANTED2/MT trial, patients were categorized into two groups (120-140 mm Hg and 140-180 mm Hg, respectively) based on achieved SBP within 24 hours after randomization. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included neurological deterioration at 7 days, major disability (mRS score of 3-5 at 90 days), hospitalization duration, and health-related quality of life assessed by the three-level EuroQoL 5-Dimension Self-Report Questionnaire (EQ-5D-3L) at 90 days. Safety outcomes included early neurological decline (END), 90-day mortality, symptomatic intracranial hemorrhage (sICH), and any intracranial hemorrhage (ICH). Treatment effects were expressed as ORs with 95% confidence intervals (CIs). RESULTS: A total of 611 patients (363 in the 120-140 mm Hg group and 248 in the 140-180 mm Hg group) were included. The mean (SD) age was 67 (12) years and 37.8% were female. After adjusting for confounders, the 120-140 mm Hg group was significantly associated with better functional outcomes (mRS: 2 (IQR 1-4) vs 2 (IQR 1-5); adjusted OR 1.54 (95% CI 1.10 to 2.17), P=0.013). Compared with the 140-180 mm Hg group, the 120-140 mm Hg group had lower rates of neurological deterioration at 7 days (adjusted OR 0.68 (95% CI 0.47 to 0.98), P=0.037) and 90-day mortality (47 (13.0%) vs 53 (21.4%); adjusted OR 0.48 (95% CI 0.27 to 0.86), P=0.013). There were no significant differences between groups in END, major disability at 90 days, hospitalization duration, EQ-5D-3L score, sICH, or ICH (all P>0.05). CONCLUSIONS: In patients with successful reperfusion after endovascular thrombectomy, an average SBP within 24 hours of 120-140 mm Hg was associated with a greater likelihood of functional independence compared with 140-180 mm Hg.

References

1. 1.Liu, Y., Zhu, X., Zhang, D., Li, Z., Zhang, G., Zheng, H., Lan, D., Qin, H., Shen, H., Xing, P., Yang, P., Zhang, L., Zhang, Y., Zhang, X., Ye, X., Wen, C., Zhong, H., & Liu, J. (2026). 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. https://doi.org/10.1136/jnis-2025-023697