Abstract Number: Esoc2026a2422 Intensive Versus Standard Blood Pressure Control After Thrombolysis for Ischemic Stroke: a Randomized Controlled Trial and the Prognostic Value of Cerebral Oximetry
Year: 2026
Type: conference-abstract
Abstract: Background and aims Optimal blood pressure (BP) control after reperfusion for acute ischemic stroke is critical yet controversial. We aimed to compare an intensive (SBP <160 mmHg) versus standard (SBP 161-185 mmHg) BP strategy after intravenous thrombolysis (TLT) and assess the prognostic value of non-invasive cerebral oximetry. Methods In this single-center trial, we randomized 64 adults with AIS undergoing TLT to intensive (n=30) or standard (n=34) BP control for 24 hours. Primary endpoints were 90-day mortality and good functional outcome (modified Rankin Scale [mRS] 0-2). A secondary analysis evaluated the interhemispheric difference in regional cerebral oxygen saturation (ΔrSO2) as an outcome predictor. Results Mean 24-hour SBP was 8.9 mmHg lower in the intensive group (145.2±10.8 vs. 154.1±10.3 mmHg; p<0.001). Neither 90-day mortality (OR 1.1, 95% CI 0.3–4.8) nor good functional outcome (OR 1.3, 95% CI 0.4–3.7) differed between groups. No symptomatic hemorrhages occurred, but any intracranial hemorrhage was numerically higher in the intensive arm (27.3% vs. 13.9%; p=0.27). An interhemispheric ΔrSO2 <4% at 24 hours independently predicted good functional outcome (adj. OR 12, 95% CI 1.6–93.7; p=0.017). Conclusions An intensive BP-lowering strategy (SBP <160 mmHg) after TLT did not improve 90-day outcomes, reinforcing the safety of current guidelines (target SBP <185 mmHg). While this intervention failed, non-invasive cerebral oximetry emerges as a strong prognostic tool. A smaller interhemispheric oxygenation difference (ΔrSO2 <4%) independently predicted superior recovery, identifying patients poised for favorable outcomes post-reperfusion. Conflict of interest Kostiantyn Stepanchenko and Alla Zhidkova nothing to disclose
Source: European Stroke Journal
Authors: Kostiantyn Stepanchenko, Alla Zhidkova
Institution: Kharkiv National Medical University
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
OpenAlex ID: W7160419612
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