Effects of Intensive Blood Pressure Lowering on Brain Swelling in Thrombolyzed Acute Ischemic Stroke: The ENCHANTED Results

作者：Guobin Zhang, Chen Chen, Xinwen Ren, Yang Zhao, Menglu Ouyang, Laurent Billot, Qiang Li, Xia Wang, Luyun Zhang, Sheila Ong, Leibo Liu, Shoujiang You, Richard I. Lindley, Thompson Robinson, Gang Li, Xiaoying Chen, Yi Sui, Craig S. Anderson, Lili Song, Martín Krause, Miriam Priglinger, Susan Day, S. Jala, Lucy Davies, C. Delcourt, Cheryl Carcel, Alejandra Malavera, Emma Ray, Craig S. Anderson, Tissa Wijeratne, Sherisse Celestino, Linda Law, G. André Ng, Ken Nagao, Gary Weiss, N.F. Titton, C. Batista, D. Zãn, Leonardo Augusto Carbonera, Kathleen Ferreira, Ricardo Lessa de Castro, R.K. Martins Filho, M. Carvalho, Milena C Libardi, Gustavo Miranda Martins, D. Leite Fagundes, Gabriel Baron, Andrew Boehringer, J. Barbosa, Rodrigo Bazán, Geórgia de Carvalho Braga, Gustavo José Luvizutto, Priscila Watson Ribeiro, Fernanda Cristina Winckler, Carla Heloísa Cabral Moro, Alexandre Luiz Longo, R. Liberato, Roberto Ramos Barbosa, Pedro Magalhães, M. Portal, Kevin Martin, Andressa de Souza, Daissy Liliana Mora Cuervo, Daniel Perin, Lucas Miranda Marques, Fernanda Oliveira, Marco Battaglini, F. Lourenço, Kathleen Ferreira, G. Silva, Luís Duarte, Marta Alves, João Carlos Sousa, M. Uhehara, Alejandro M. Brunser, Enrico Mazzon, M. Spencer, Indrani Acosta, A. Rojo, R. Rivas, C Klapp, L. Carvallo, Pamela Carvallo, Eloy Mansilla, J. Flores, M. Alvarado, Alex F. Herrera, Carolina Reyes, F. Jurado, Gabriela Bustamante, Laura Bravo, José Manuel Matamala, Rodrigo Guerrero, G. Chen, Shuyu Zhou, Ping Li, Wei Liu, L. Liu, Yaohua Tian, Huiling Xu, Jing Wang, Guojun Wu, Lei Wang, Z. Zhen, Lei Wang, Jinli Zhang, Min Yan, Lei Wang, Qi Zhang, X. Tao, Chuanfu Liu, Yiwei Cao, Jie Shi, Shoujiang You, Xiaolei Zhang, L. Tai, Lei Xu, Hung‐I Lu, H. Nie, Xianchan Li, Junshan Zhou, Yajie Liu, Ping Gong, Yaohua Tian, H. Zhao, Jinli Zhang, Ruikun Li, Xia Wang, Q. Chen, Longfei Wu, Jinli Zhang, Lijun Jia, Xiaonan Guo, Xianchan Li, G. Chen, Binshan Lin, Wusheng Zhu, Kun Yang, Jinli Zhang, Zheng Zhang, Chenglong Xie, Dawei Wu, Zheng Zhang, Xianchan Li, Yi Wang, D. Liu, Z. Liu, Liming Liang, Qi Cao, Xiaolei Zhang, Jinglin Xia, Xianchan Li, Yiyun Weng, Jianping Li, Tongren Xu, Deqin Geng, Xiuli Yan, D. Wang, Naisi Zhao, Jianping Li, D. Wang, Z. Tang, Lei Wang, Weihua Yin, Lingling Wang, D. Wang, Wei Huang, Yuan‐Han Yang, Anna Song, Yonggang Hao, A. Zhang, B. Qiao, Jie Yang, H. Yan, X. Wei, Z. Tao, Huan Liu, Ying Lv, Heping Yang, Lijuan Han, Xueting Mao, Lijun Ge, Yi Zhang, Shulin He, H. Zhao, Qi Zhang, Jian Jiang, Min Yan, Yi Wang, D. Liu, Wen‐Chuan Wu, Hui Wang, Yang Li, Gang Li, Yujie Tang, Hongbin Sun, F. Li, Yirui Sun, Cong Geng, Lili Song, Hongjian Zhang, Yu‐Peng Wu, Li-Ting Huang, Zheng Zhang, Jianbing Zhu, F. Zhang, Zhengming Jin, Rongqin Zheng, Qinhe Yang, Wen Zheng, Xincun Zhuang, Xiaoying Chen, Ling Li, Juan Du, Ying‐Ju Lai, Yu Zhou, Hongfei Duan, Qi Cao, En Xu, Q. Lin, Liying Zhan, J. Wu, Chenchen Wei, X. Feng, Qiu-Sha Huang, Yang Li, X. Liu, Jianbo He, B. Wang, Wei Li, P. Chen, Xueliang Zeng, Fengmei Guo, Hancheng Dai, Q. Su, F. Long, Bin Chen, D. Wang, Min Dai, H. Nie, Xintong Wu, Ting Wu, Bo‐Ying Bao, Yi Wang, Y. Xu, Yuanhua Shao, Xiaolei Zhang, Shun Li, Ferran Silva, Jason Castellanos, M.A. Malavera, M. Muñoz-Collazos, E. Solano, W.H.T. Leung, S. Sureshbabu, Shashank Shekhar, S.K. Singla, Lokesh Saini, SUNITA SUNITA, Mahesh Kate, R. Sarvotham, Akanksha Grace William, A. Deepak, Mohanti Bk, Sanjeev Sharma, S. K, Paterson Kr, Sarah George, R. Benny, Vyankatesh Bolegave, M.F. Baslé, Stephen Gore, Pravin George, S. Kumaravelu, S. Rahamath, Preeti Raj, Akella Radha Rama Devi, Arvind Sharma, Jayesh Prajapati, Mahesh Parmar, Darshan Patel, Terry Panchal, Sankar Prasad Gorthi, Varun V. Prabhu, Arvind Prabhu, V. Chandran, Anjan Chatterjee, Radhika Nair, Vivek Nambiar, D. TS, S. TP, Amrutha V Ajai, Sonal Paul, P.C. Natarajan, D. Chittibabu, Nomal Chandra Borah, M. Ghose, Nusrat Choudhury, P. Gohain, K. Kalita, D. Duberkar, Nisha Pawar, R. Bhaviskar, Stefano Ricci, E. Caterbi, Silvia Cenciarelli, R Condurso, E. Gallinella, Laura Greco, Cindy Marando, S. Mastrocola, A. Mattioni, Elisa Sacchini, I. Sicilia, Andrea Gallina, David Giannandrea, E Marsili, Tatiana Mazzoli, Chiara Padiglioni, Francesco Corea, Arianna Guidubaldi, Sara Micheli, Mali Barbi, Jinkwon Kim, Hee‐Jung Song, Hayeong Jeong, Johnny Lim, Sang‐Min Park, K.B. Lee, H.W. Hwang, Jong S. Kim, Seong Uk Kwon, Dong‐Wha Kang, Young Jin Kim, Beom Joon Kim, J.M. Park, Kristan Kang, Beom Joon Kim, Ohseong Kwon, J.J. Lee, Young Woo Kim, Yang‐Ha Hwang, Hyuksool Kwon, Jaseong Koo, Kyoung Bun Lee, T. Kim, Anna Ahn, Joung‐Ho Rha, H.K. Park, C.W. Yoon, Bernard P.L. Chan, Hock‐Luen Teoh, Prakash Paliwal, L.Y.J. Wong, J.T. Chen, Vijay K. Sharma, Deidre Anne De Silva, H.M. Chang, Natasha L. Fabiaña, Josep Martí, Rafaël Delgado, Alicia Martínez, Laura Trafí i Prats, Pelayo Camps, Chia‐Wei Liou, Thean Yen Tan, Chuanfu Liu, Henry Cheng, Helen L. Po, Yufeng Lin, Chieh Chou, Chun-Hsien Lin, C. C. Yen, Yu‐Tzu Chang, Yueh‐Han Hsu, Joshua D. Lee, Meng Lee, Yuwen Huang, Yuwen Huang, Chun‐Yu Wu, Nijasri C. Suwanwela, Aurauma Chutinet, Yuttachai Likitjaroen, Duangnapa Roongpiboonsopit, S. Charnwut, Alexander Dyker, Mohammad Zakir Hossain, Girish Muddegowda, R. Sanyal, Christine Roffe, Indira Natarajan, K. Finney, L. Sztriha, James Teo, Francis K.L. Chan, Jonathan Lim, Belinda Chitando, Brian Clarke, Bhakti K. Patel, Usman Khan, Rita Ghatala, Sarah Trippier, Lalit Kalra, Dulka Manawadu, Nyma Sikondari, J Aeron‐Thomas, W Sunman, Gail M. Wilkes, Caroline R. Richardson, A. Buch, J. Brooks Jackson, Omid Halse, Sheila Mashate, Peter Wilding, Thi Van Anh Nguyen, K. Rashed, M.R. Qadiri, S. Board, C Buckley, Craig J. Smith, Martin James, Sharon Keenan, A. Bouring, Timothy J. England, R. Donnelly, Jon Scott, M. Maddula, J. Beavan, Richard Perry, Nadia Francia, C. Watchhurst, A. Banaras, Amy Ashton, Amit Mistri, K. Musarrat, Lisa Manning, Thompson Robinson, D. Eveson, J. Kallingal, J. M. Perez, Linda Harrison, Tracy Marsden, M.J. Macleod, Jacqueline Furnace, Robert Clarke, Joanne Reid, Elizabeth A. Warburton, Jennifer Mitchell, Diana J. Day, Nicholas Church, Edward S. Amis, Christopher Price, Helen Rodgers, Robert F. Whiting, Malik Azhar Hussain, Mark Harvey, Simon G.A. Brown, Jayne Foot, Dinesh Tryambake, David Broughton, Ann M. Bergin, Al. Annamalai, Luke Dixon, N. Weir, Christian U. Blank, K. Harkness, A. Ali, Emma Richards, Karen Stocks, David Bruce, Mushtaq Ahmad Wani, Tal Anjum, Manju Krishnan, T. Nguyen Huy, A. Truong Le Tuan, Luis Cam, T. Ngo Thi Kim, Binh-Thanh Nguyen, A. Nguyen Dat, C. Nguyen Van, T. Mai Duy, P. Dao Viet, Deborah Tien, T. Vo Van, Kyuseok Kim, T. Bui Ngoc, T. Tran Le Thanh, S. Nguyen Hoanh, S. Pham Phuoc, T. Tran Van, Bùi Thị, Huong Nguyen Thu, M. Nguyen Duy, D. Ngo Van · 发表于：Stroke · 年份：2025 · DOI：10.1161/strokeaha.124.049938 · 被引用次数：3 · 研究领域：Acute Ischemic Stroke Management、Traumatic Brain Injury and Neurovascular Disturbances、S100 Proteins and Annexins

BACKGROUND: Cerebral swelling in relation to cytotoxic edema is a predictor of poor outcome in acute ischemic stroke (AIS) and elevated blood pressure (BP) promotes its development. Whether intensive BP-lowering treatment reduces cerebral swelling is uncertain. We aimed to determine whether intensive BP lowering reduces the severity of cerebral swelling after thrombolysis for AIS. METHODS: A secondary analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial factorial, international, multicenter, open-label, blinded end point, randomized controlled trial of alteplase dose and levels of BP control in thrombolyzed patients with AIS. Participants were randomly assigned to intensive (systolic target 130–140 mm Hg within 1 hour; maintained for 72 hours) or guideline-recommended (systolic target <180 mm Hg) BP management. Available serial brain images (baseline and follow-up, computed tomography, or magnetic resonance imaging) were centrally analyzed with standardized techniques (Apollo MIStar software) by expert readers blind to clinical details to rate swelling severity (from 0 no to 6 most severe swelling [midline shift and effacement of basal cisterns]) and other abnormalities. Primary outcome was any cerebral swelling (score, 1–6) in logistic regression models. RESULTS: Of 1477/2196 (67.3%) patients (mean age, 67.7 years; female, 39.6%) with sequential scans, the between-group mean systolic BP difference was 6.6 mm Hg over 24 hour...