Outcome in Patients Treated with Intra-arterial thrombectomy: The optiMAL Blood Pressure control (OPTIMAL-BP) Trial
Authors
Hyo Suk Nam ; Young Dae Kim ; Jin Kyo Choi ; Minyoul Baik ; Byung Moon Kim ; Dong Joon Kim ; JoonNyung Heo ; Dong Hoon Shin ; Kyung-Yul Lee ; Yo Han Jung ; Jang-Hyun Baek ; Yang-Ha Hwang ; Sung-Il Sohn ; Jeong-Ho Hong ; Hyungjong Park ; Chi Kyung Kim ; Gyu Sik Kim ; Kwon-Duk Seo ; Kijeong Lee ; Jung Hwa Seo ; Oh Young Bang ; Woo-Keun Seo ; Jong-Won Chung ; Jun Young Chang ; Sun U Kwon ; Jun Lee ; Jinkwon Kim ; Joonsang Yoo ; Tae-Jin Song ; Seong Hwan Ahn ; Bang-Hoon Cho ; Han-Jin Cho ; Jae Guk Kim ; Yoonkyung Chang ; Chan Joo Lee ; Sungha Park ; Goeun Park ; Hye S Lee
Citation
INTERNATIONAL JOURNAL OF STROKE, Vol.17(8) : 931-937, 2022-10
Rationale: Very early stage blood pressure (BP) levels may affect outcome in stroke patients who have successfully undergone recanalization following intra-arterial treatment, but the optimal target of BP management remains uncertain.
Aim: We hypothesized that the clinical outcome after intensive BP-lowering is superior to conventional BP control after successful recanalization by intra-arterial treatment.
Sample-size estimates: We aim to randomize 668 patients (334 per arm), 1:1.
Methods and design: We initiated a multicenter, prospective, randomized, open-label trial with a blinded end-point assessment (PROBE) design. After successful recanalization (thrombolysis in cerebral infarction score ≥ 2 b), patients with elevated systolic BP level, defined as the mean of two readings ≥ 140 mmHg, will be randomly assigned to the intensive BP-lowering (systolic BP < 140 mm Hg) group or the conventional BP-lowering (systolic BP, 140-180 mm Hg) group.
Study outcomes: The primary efficacy outcomes are from dichotomized analysis of modified Rankin Scale (mRS) scores at three months (mRS scores: 0-2 vs. 3-6). The primary safety outcomes are symptomatic intracerebral hemorrhage and death within three months.
Discussion: The OPTIMAL-BP trial will provide evidence for the effectiveness of active BP control to achieve systolic BP < 140 mmHg during 24 h in patients with successful recanalization after intra-arterial treatment.