Intensive Versus Standard Blood Pressure Control After Endovascular Thrombectomy in Acute Ischemic Stroke: A Meta‐Analysis of Randomized Controlled Trials

BACKGROUND: The optimal strategy for blood pressure management following mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion remains a subject of ongoing research. METHODS: We comprehensively searched PubMed, Embase, and the Cochrane Library from inception to June 20, 2025. Randomized controlled trials comparing intensive versus standard blood pressure control following mechanical thrombectomy for acute ischemic stroke were included. The primary outcomes were excellent functional outcome (modified Rankin Scale score 0-1 at 90 days) and good functional outcome (modified Rankin Scale score 0-2 at 90 days). Pooled odds ratios (ORs) with 95% CIs were calculated using a random-effects model. RESULTS: A total of 6 randomized controlled trials were included. The pooled estimates indicated that intensive blood pressure control was associated with lower rates of good functional outcome (OR, 0.70 [95% CI, 0.54-0.91]), an increased likelihood of all-cause mortality (OR, 1.21 [95% CI, 1.05-1.40]), and a higher incidence of hypotensive episodes (OR, 2.49 [95% CI, 1.56-3.96]). No significant differences were found in excellent functional outcome (OR, 0.91 [95% CI, 0.67-1.23]) or symptomatic intracranial hemorrhage (OR, 1.19 [95% CI, 0.89-1.61]). The overall strength of evidence was high for functional outcomes and hypotensive episodes, whereas it was moderate for all-cause mortality and symptomatic intracranial hemorrhage. CONCLUSIONS: This meta-analysis demonstrates that intensive blood pressure control following mechanical thrombectomy does not improve functional outcomes and may be associated with harm, including reduced rates of good functional outcome, increased all-cause mortality, and a higher incidence of hypotensive episodes.