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Comment & Response
October 12, 2020

Blood Pressure Thresholds During Endovascular Therapy in Ischemic Stroke—Reply

Author Affiliations
  • 1Department of Anesthesia, Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark
  • 2Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  • 3Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
JAMA Neurol. 2020;77(12):1579-1580. doi:10.1001/jamaneurol.2020.3819

In Reply We thank Sun et al for their interest in our study and questions regarding our findings suggesting that a procedural mean arterial blood pressure (MABP) greater than 90 mm Hg for a period of more than 45 minutes (with a number needed to harm of 10 patients) is associated with poor clinical outcomes.1 It is not entirely correct to state that the SIESTA, ANSTROKE, and GOLIATH trials argue for an MABP of 90 mm Hg as a ceiling threshold. Our study is a post hoc analysis of observational blood pressure (BP) data from the 3 trials in which patients with acute ischemic stroke and large vessel occlusion in the anterior circulation were randomized to either general anesthesia or procedural sedation for thrombectomy, with clinical or imaging end points as the primary outcomes. The BP protocols in the 3 trials were comparable, aiming for systolic BP greater than 140 to 160 or 180 mm Hg.1

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