{
  "abstract": "Background Intensive blood pressure (BP) lowering after successful endovascular thrombectomy (EVT) failed to improve functional outcomes, but its association with the extent of blood-brain barrier disruption remains unclear. We investigated whether Contrast Staining-Alberta Stroke Programme Early CT Score (CS-ASPECTS) and contrast staining (CS) after EVT modify the outcomes of post-EVT BP management strategy.Methods This post hoc analysis of the Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure trial included acute stroke patients who achieved successful EVT and underwent follow-up brain CT within 3 hours of randomisation to intensive (systolic BP <140 mm Hg) or conventional (140–180 mm Hg) BP management. Subgroup analyses were conducted based on CS status and CS-ASPECTS.Results Among 174 patients (mean age 72.8±12.1 years, 38.5% women), CS was present in 123 (70.7%). CS was associated with a higher rate of any intracranial haemorrhage (ICH) but not with functional outcome. CS-ASPECTS 0–6 was associated with a higher risk of symptomatic ICH and worse functional outcome compared with CS-ASPECTS 7–10. Among patients with CS-ASPECTS 7–10, intensive BP lowering was associated with a lower likelihood of functional independence (adjusted OR 0.37, 95% CI 0.15 to 0.87), whereas no significant association was observed in patients with CS-ASPECTS 0–6 (adjusted OR 1.29, 95% CI 0.20 to 9.09) (P for interaction=0.044). There was no significant heterogeneity between BP management strategy and CS-ASPECTS for symptomatic intracerebral haemorrhage or mortality.Conclusions CS-ASPECTS, but not CS alone, was associated with functional outcome and identified heterogeneity in the association between post-EVT BP lowering and functional independence. These exploratory findings warrant prospective validation before clinical application.Trial registration number NCT04205305.",
  "authors": [
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Jae Wook Jung"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Young Dae Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "JoonNyung Heo"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Hyungwoo Lee"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Byungjae Kim"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Byung Moon Kim"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Dong Joon Kim"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Na-Young Shin"
    },
    {
      "affiliations": [
        "Department of Radiology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Haram Joo"
    },
    {
      "affiliations": [
        "Department of Neurology, Korea University Anam Hospital and College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Bang-Hoon Cho"
    },
    {
      "affiliations": [
        "Department of Neurology, Chosun University Hospital, Gwang-Ju, Korea (the Republic of)"
      ],
      "name": "Seong Hwan Ahn"
    },
    {
      "affiliations": [
        "Department of Neurology, Kyungpook National University Hospital, Daegu, Daegu, Korea (the Republic of)"
      ],
      "name": "Hyungjong Park"
    },
    {
      "affiliations": [
        "Department of Neurology, Keimyung University College of Medicine, Daegu, Korea (the Republic of)"
      ],
      "name": "Sung-Il Sohn"
    },
    {
      "affiliations": [
        "Department of Neurology, Keimyung University College of Medicine, Daegu, Korea (the Republic of)"
      ],
      "name": "Jeong-Ho Hong"
    },
    {
      "affiliations": [
        "Department of Neurology, Pusan National University School of Medicine, Busan, Busan, Korea (the Republic of)"
      ],
      "name": "Jaeseob Yun"
    },
    {
      "affiliations": [
        "Department of Neurology, Ewha Womans University Seoul Hospital, Seoul, Korea (the Republic of)"
      ],
      "name": "Tae-Jin Song"
    },
    {
      "affiliations": [
        "Department of Neurology, Ewha Womans University Mokdong Hospital, Seoul, Korea (the Republic of)"
      ],
      "name": "Yoonkyung Chang"
    },
    {
      "affiliations": [
        "Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea (the Republic of)"
      ],
      "name": "Gyu Sik Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Asan Medical Center, Seoul, Korea (the Republic of)"
      ],
      "name": "Jun Young Chang"
    },
    {
      "affiliations": [
        "Department of Neurology, Dong-a University Hospital, Busan, Korea (the Republic of)"
      ],
      "name": "Jung Hwa Seo"
    },
    {
      "affiliations": [
        "Department of Neurology, Inje University College of Medicine, Busan, Korea (the Republic of)"
      ],
      "name": "Sukyoon Lee"
    },
    {
      "affiliations": [
        "Department of Neurology, Kangbuk Samsung Hospital, Seoul, Korea (the Republic of)"
      ],
      "name": "Jang-Hyun Baek"
    },
    {
      "affiliations": [
        "Department of Neurology, Pusan National University School of Medicine, Busan, Busan, Korea (the Republic of)"
      ],
      "name": "Han Jin Cho"
    },
    {
      "affiliations": [
        "Department of Neurology, School of Medicine, Ajou University, Suwon, Korea (the Republic of)"
      ],
      "name": "Dong Hun Shin"
    },
    {
      "affiliations": [
        "Department of Neurology, Yongin Severance Hospital, Yongin-si, Korea (the Republic of)"
      ],
      "name": "Jinkwon Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Yongin Severance Hospital, Yongin-si, Korea (the Republic of)"
      ],
      "name": "Joonsang Yoo"
    },
    {
      "affiliations": [
        "Department of Neurology, Yongin Severance Hospital, Yongin-si, Korea (the Republic of)"
      ],
      "name": "Minyoul Baik"
    },
    {
      "affiliations": [
        "Department of Neurology, Gangnam Severance Hospital, Seoul, Korea (the Republic of)"
      ],
      "name": "Yo Han Jung"
    },
    {
      "affiliations": [
        "Department of Radiology, Gangnam Severance Hospital, Seoul, Korea (the Republic of)"
      ],
      "name": "Kwon-Duk Seo"
    },
    {
      "affiliations": [
        "Department of Neurology, Kyungpook National University Hospital, Daegu, Daegu, Korea (the Republic of)"
      ],
      "name": "Yang-Ha Hwang"
    },
    {
      "affiliations": [
        "Department of Neurology, Korea University Guro Hospital, Seoul, Korea (the Republic of)"
      ],
      "name": "Chi Kyung Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Eulji University Hospital, Daejeon, Korea (the Republic of)"
      ],
      "name": "Jae Guk Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Korea (the Republic of)"
      ],
      "name": "Il Hyung Lee"
    },
    {
      "affiliations": [
        "Department of Neurology, Seoul Medical Center, Jungnang-gu, Korea (the Republic of)"
      ],
      "name": "Jin Kyo Choi"
    },
    {
      "affiliations": [
        "Department of Research Affairs, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Soyoung Jeon"
    },
    {
      "affiliations": [
        "Biostatistics, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Hye Sun Lee"
    },
    {
      "affiliations": [
        "Department of Neurology, Kyungpook National University Chilgok Hospital, Buk-gu, Korea (the Republic of)"
      ],
      "name": "Kwang Hyun Kim"
    },
    {
      "affiliations": [
        "Department of Neurology, Asan Medical Center, Seoul, Korea (the Republic of)"
      ],
      "name": "Sun U Kwon"
    },
    {
      "affiliations": [
        "Department of Neurology, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea (the Republic of)"
      ],
      "name": "Oh Young Bang"
    },
    {
      "affiliations": [
        "Department of Neurology, CHA University Bundang Medical Center, Seongnam-si, Korea (the Republic of)"
      ],
      "name": "Ji Hoe Heo"
    },
    {
      "affiliations": [
        "Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)"
      ],
      "name": "Hyo Suk Nam"
    }
  ],
  "title": "Association of intensive blood pressure lowering after endovascular thrombectomy with outcomes according to contrast staining ASPECTS",
  "uid": "83e0b79f-28c7-5623-aae5-b2badbcb49bd"
}