Systolic blood pressure targets after successful endovascular thrombectomy: a network meta-analysis of randomized controlled trials
In brief
Targets below 140 mmHg were associated with worse outcomes after thrombectomy
In an eight-study analysis, systolic blood pressure targets below 140 mmHg, including below 120 mmHg, were associated with worse functional outcomes after successful thrombectomy; a target below 180 mmHg ranked highest for functional independence. Bleeding and 90-day mortality did not differ significantly, but variation across disability levels and study-group data leave individualized targets unresolved.
- Journal
- Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (Q1)
- Published
- 29 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Jiarong Zhu, Mu He, Yuyan Lu, Liang Zhou, Guirong Dong
- PMID
- 42809028
- DOI
- 10.1007/s10072-026-09418-1
Why clinicians should know about it
- Picked for Neurology (clinical) (paper of the day, 30 September 2026): SBP targets after thrombectomy, network meta‑analysis of RCTs
Abstract
BACKGROUND: Uncertainty persists regarding the optimal systolic blood pressure (SBP) target after thrombectomy, as systemic blood pressure may affect the penumbra and associated microcirculatory perfusion. We evaluated the impact of different SBP targets on outcomes and the dose-response relationship between actual 24-hour mean SBP and functional outcomes. METHODS: We systematically reviewed studies comparing SBP targets after thrombectomy. Bayesian network meta-analysis assessed functional independence and safety. Multi-threshold sensitivity analyses tested the proportional odds assumption across disability levels. Study-level meta-regression explored the association between 24-hour mean SBP and functional outcomes. RESULTS: Eight studies were included. The < 180 mmHg target ranked highest for functional independence (SUCRA = 87.3% (50.0%-100.0%)), while < 140 mmHg (SUCRA = 26.3%, OR = 1.65 (1.03-2.54)) and < 120 mmHg (SUCRA = 17.7%, OR = 1.75 (1.14-2.71)) were associated with worse outcomes, and the certainty of the evidence was high. No significant differences in symptomatic intracranial hemorrhage or 90-day mortality were observed. Among six study-level comparisons, five violated the proportional odds assumption, indicating effect heterogeneity across disability levels.An exploratory group-level meta-regression showed that, within the observed range of 117-139 mmHg, higher actual SBP was associated with a higher odds ratio for functional independence at the study group level (OR = 1.028 (1.015-1.041)). CONCLUSIONS: After successful recanalization, clinicians should avoid excessive SBP reduction. Future studies should consider reperfusion status, the burden of ischemic injury, and tissue perfusion to determine individualized blood pressure targets.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.