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

Yifeng Liu; Xuan Zhu; Donghuan Zhang; Zhaoshuo Li; Gaoqi Zhang; Haocun Zheng; Duanyun Lan; Hao Qin; Hongjian Shen; Pengfei Xing; Pengfei Yang; Lei Zhang; Yongwei Zhang; Xiaoxi Zhang; Xiaofei Ye; Changming Wen; Hailong Zhong; Jianmin Liu; ENCHANTED2/MT Investigators

doi:10.1136/jnis-2025-023697

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

J Neurointerv Surg. 2025 Jul 15:jnis-2025-023697. doi: 10.1136/jnis-2025-023697. Online ahead of print.

Authors

Yifeng Liu^#¹, Xuan Zhu^#², Donghuan Zhang^#¹, Zhaoshuo Li³, Gaoqi Zhang¹, Haocun Zheng¹, Duanyun Lan¹, Hao Qin¹, Hongjian Shen², Pengfei Xing², Pengfei Yang², Lei Zhang², Yongwei Zhang², Xiaoxi Zhang², Xiaofei Ye⁴, Changming Wen⁵, Hailong Zhong^{6

7}, Jianmin Liu²; ENCHANTED2/MT Investigators

Collaborators

ENCHANTED2/MT Investigators:
Lili Song, Xiaoying Chen, Xia Wang, Jianmin Liu, Pengfei Yang, Yongwei Zhang, China Mark Parsons, Ken Butcher, Thompson Robinson, Bruce Campbell, Mayank Goyal, Charles Majoie, Yvo Roos, Diederik Dippel, Longde Wang, Yongjun Wang, Graeme J Hankey, Catharina Jm Karin Klijn, Zhongrong Miao, Bin Peng, Laurent Billot, Qiang Li, Xinwen Ren, Rong Yin, Yingying Zhang, Qiang Li, Yunke Li, Yingfeng Wan, Lingli Sun, Jianping Lu, Bing Tian, Yongxin Zhang, Xia Tian, Wenjin Yang, Gao Ma, Yuxi Hou, Xuefeng Zhang, Wenjia Peng, Li Wang, Weilong Hua, Shenqiang Yan, Zhang Shi, Jun Ke, Jun Shi, Cedar Wang, Xin Wang, Xueyan Ke, Hao Wang, Renkun Zhang, Guang Zhang, Peng Ma, Lei Zhang, Zhinan Pan, Meng Zhang, Zidong Wang, Jiwei Wang, Qingyang Cao, Jiaxing Dai, Dinglai Lin, Qunlong Jiang, Huajun Ba, Qun Lin, Bing Tian, Gao Ma, Xia Tian Li Wang, Wenjia Peng, Weilong Hua, Xuefeng Zhang, Wenjin Yang, Shenqiang Yan, Zhang Shi, Yuxi Hou, Jun Ke, Jin Li, Chen Guo, Wenjin Yang, Zhinan Pan, Zidong Wang, Dinglai Lin, Tianwei Jiang, Hongyang Sun, Huaming Shao, Jiaxing Dai, Peng Ma, Lisan Zeng, Qunlong Jiang, Qingyang Cao, Hui Li, Renkun Zhang, Huajun Ba, Qun Lin, Shenqiang Yan, Xiaohui Lin, Hao Wang, Lifeng Xu, Meng Zhang, Yongxin Zhang, Yanqing Wang, Jipeng Cheng, Yiwen Peng, Wenjing Li, Chuchu You, Lilan Zhang, Guojuan Cheng, Sharon Shen, Miao Yu, Zhijie Hao, Yajie Chen, Yilin Dong, Wenjing Yu, Le Dong Li Yuan, Yi Ning, Brook Li, Joyce Lim, Helen Monaghan

Affiliations

¹ Department of Neurology, Nanyang Central Hospital, Nanyang, Henan, China.
² Neurovascular Center, Changhai Hospital, Shanghai, Shanghai, China.
³ Department of Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, Henan, China.
⁴ Department of Statistics, Naval Medical University, Shanghai, Shanghai, China.
⁵ Department of Neurology, Nanyang Central Hospital, Nanyang, Henan, China 554425287@qq.com 13838729696@sina.com.
⁶ Beijing Neurosurgical Institute, Beijing, Beijing, China 554425287@qq.com 13838729696@sina.com.
⁷ Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing, Beijing, China.

^# Contributed equally.

PMID: 40664427
DOI: 10.1136/jnis-2025-023697

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.

Keywords: Blood Pressure; Stroke; Thrombectomy.