Abstract WP345: Blood Pressure Control Post-Endovascular Stroke Treatment: Evidence from an Updated Meta-Analysis of Functional and Safety Outcomes

Background: Previous meta-analyses evaluating blood pressure (BP) management following endovascular stroke treatment (EVT) demonstrated a non-significant effect on all-cause mortality (OR 1.30; 95% CI 0.98–1.71). The recently published IDENTITY trial, a randomized controlled study, provides new data that may influence these findings. Methods: We conducted a systematic review and meta-analysis of all six published randomized controlled trials (RCTs) (n = 1,945 patients) comparing: Intensive BP control: target systolic BP <130 mmHg Conventional BP control: target systolic BP 140–180 mmHg Primary outcomes were 90-day all-cause mortality and functional independence (modified Rankin Scale [mRS] 0–2). Secondary outcomes included unfavorable recovery (mRS 3–6), symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage (ICH), and malignant edema. Pooled odds ratios (ORs) were calculated using a random-effects model. Results: Mortality: In prior analyses, mortality differences were non-significant (OR 1.30, 95% CI 0.98–1.71). Incorporating IDENTITY trial data rendered the mortality difference statistically significant, with 26% higher mortality in the conventional BP group (OR 1.26, 95% CI 1.00–1.60; p = 0.05, corresponding to a 21% mortality reduction with intensive BP control (1/1.26 = 0.79). Functional Outcomes: Intensive BP control was associated with 32% lower odds of good functional outcome (mRS 0–2) (OR 0.68, 95% CI 0.57–0.82; p < 0.001) and 47% higher odds of unfavorable recovery (mRS 3–6) (OR 1.47, 95% CI 1.23–1.77). Safety Outcomes: No significant differences were found in sICH (OR 1.18, 95% CI 0.84–1.65) or any ICH (OR 1.10, 95% CI 0.91–1.32). A non-significant trend toward higher malignant edema was observed with intensive BP control (OR 1.86, 95% CI 0.94–3.68). Conclusion: This updated meta-analysis of six RCTs, including the IDENTITY trial, indicates that intensive BP management after EVT significantly reduces all-cause mortality but is associated with worse functional outcomes. Safety outcomes remain largely unchanged. These findings underscore the complexity of post-EVT BP management and the need for further trials to determine optimal treatment strategies.