Outcome in Patients Treated With Intraarterial Thrombectomy - optiMAL Blood Pressure Control (OPTIMAL-BP)
Status:
Recruiting
Trial end date:
2024-12-01
Target enrollment:
Participant gender:
Summary
Recent endovascular thrombectomy (EVT) trial have proven the effectiveness of intraarterial
revascularization in patients with larger cerebral artery occlusion. The success rate of EVT
is close to 80%, but only 50% of patients improve to independent functional outcome.
Therefore, new treatment strategies are needed to reduce the futile revascularization.
However, updated guidelines recommend the indications for EVT based on the results of
randomized clinical trials (RCT), management of post-revascularization is largely unknown.
Current guidelines suggest that systolic blood pressure should be adjusted below 180 mmHg and
diastolic blood pressure below 105 mmHg in patients undergoing intraarterial reopening.
However, in the case of successful recanalization by EVT, same guideline is adopted even
though the possibility of intracerebral hemorrhage or reperfusion injury by high blood
pressure. On the other hand, too low blood pressure can worsen cerebral ischemia.
Therefore, this study will compare the effectiveness of active blood pressure control group
(with less than 140 mmHg systolic blood pressure) versus standard blood pressure control
group (with less than 180 mmHg systolic blood pressure) during the first 24 hours in patients
who underwent EVT and achieved successful recanalization (TICI 2b-3). The goal is to reach
the target blood pressure within 60 minutes of randomization.