Individualized vs Standard Blood Pressure Control During Thrombectomy for Ischemic Stroke: The DETERMINE Randomized Clinical Trial.
Individualized blood pressure control did not improve functional outcomes after thrombectomy.
Individualized vs Standard Blood Pressure Control During Thrombectomy for Ischemic Stroke: The DETERMINE Randomized Clinical Trial.
Current recommended blood pressure (blood pressure) targets during mechanical thrombectomy (mechanical thrombectomy) rely on a one-size-fits-all approach aiming at preventing hypertension.
We aimed to evaluate whether an individualized blood pressure control during mechanical thrombectomy could improve functional outcome at 90 days.
Were randomly assigned (1:1) to an individualized blood pressure group during mechanical thrombectomy (where the mean arterial pressure [MAP] was maintained within 10% of the first MAP measured before mechanical thrombectomy) or a control blood pressure group (systolic blood pressure maintained within 140 and 180 mm Hg).
individualized blood pressure control did not raise odds of good outcome, favoring standard control
Overall, 433 patients (median age, 69.3 years, 228 females [52.8%]) were assigned to an individualized blood pressure group (n = 215) or the control blood pressure group (n = 218); one was excluded because of consent withdrawal.
No significant differences in mean blood pressure levels or blood pressure variability were observed between groups during the procedure.
Mortality from any cause at 90 days was not significantly different between groups (18.8% in the individualized blood pressure group vs 16.4% in the control blood pressure group: adjusted odds ratio, 1.19; 95% CI 0.70-2.03).
Rates of symptomatic intracranial hemorrhages were not different between the 2 groups.
DISCUSSION: In patients with acute ischemic stroke due to an anterior large vessel occlusion, an individualized blood pressure management during mechanical thrombectomy did not increase rates of favorable functional outcome at 90 days compared with a standard blood pressure management.