Acute Kidney Injury After Intensive Blood Pressure Lowering Following Successful Endovascular Thrombectomy.

Authors

Jae Wook Jung, Hee Byung Koh, Young Dae Kim, JoonNyung Heo, Hyungwoo Lee, Byung Moon Kim, Dong Joon Kim, Na-Young Shin, Sungwook Yu, Seong Hwan Ahn, Sung-Il Sohn, Jeong-Ho Hong, Tae-Jin Song, Yoonkyung Chang, Gyu Sik Kim, Taedong Ok, Jun Young Chang, Jung Hwa Seo, Sukyoon Lee, Jang-Hyun Baek, Han-Jin Cho, Jaeseob Yun, Dong Hoon Shin, Sang Hee Ha, Jinkwon Kim, Joonsang Yoo, Minyoul Baik, Yo Han Jung, Kwon-Duk Seo, Yang-Ha Hwang, Hyungjong Park, Chi Kyung Kim, Jae Guk Kim, Il Hyung Lee, Jin Kyo Choi, Soyoung Jeon, Hye Sun Lee, Kwang Hyun Kim, Sun U Kwon, Oh Young Bang, Ji Hoe Heo, Hyo Suk Nam, OPTIMAL-BP trial investigators

Published in

Stroke. Jul 24, 2026. Epub Jul 24, 2026.

Abstract

The effect of postthrombectomy blood pressure (BP) management on the development of acute kidney injury (AKI) in patients with acute ischemic stroke remains largely unexplored.
This secondary analysis of the OPTIMAL-BP trial (Outcome in Patients Treated With Intra-Arterial Thrombectomy-Optimal Blood Pressure Control) included patients with acute ischemic stroke due to large-vessel occlusion who achieved successful endovascular thrombectomy and had a systolic BP ≥140 mm Hg. Patients were randomized to intensive (target systolic BP <140 mm Hg) or conventional (target systolic BP 140-180 mm Hg) BP management for 24 hours. The outcomes were AKI within 7 days and within 2 days, defined according to the Kidney Disease: Improving Global Outcomes criteria. In addition, we examined the associations between AKI and functional independence at 3 months, defined as a modified Rankin Scale score of 0 to 2. Multivariable logistic regression analyses were performed with adjustment for age, sex, time from stroke onset to enrollment, baseline National Institutes of Health Stroke Scale score, and baseline estimated glomerular filtration rate.
Of 306 patients, 19 were excluded, and 287 patients were included in this analysis (mean age, 73.2 years; 117 [40.8%] women). AKI within 7 days occurred more frequently in the intensive management group than in the conventional group (20/147 [13.6%] versus 9/140 [6.4%]; adjusted odds ratio, 2.54 [95% CI, 1.10-6.35]). Most AKI events were stage 1 (20/29 [69.0%]). Early AKI within 2 days was also more common with intensive BP management. Patients with AKI had significantly lower rates of functional independence (4/29 [13.8%] versus 126/257 [49.0%]; adjusted odds ratio, 0.19 [95% CI, 0.05-0.55]) and higher stroke-related mortality at 3 months (11/29 [37.9%] versus 8/257 [3.1%]; adjusted odds ratio, 13.8 [95% CI, 4.14-49.64]). In a sensitivity analysis with equal creatinine ascertainment, the association with 48-hour AKI did not reach statistical significance (7/76 [9.2%] versus 2/66 [3.0%]; adjusted odds ratio, 4.20 [95% CI, 0.83-32.6]), although the absolute risk difference remained directionally consistent.
Intensive BP lowering after successful endovascular thrombectomy was associated with a higher risk of AKI, even when kidney injury was predominantly mild. In addition, AKI was associated with worse neurological outcomes. These findings suggest that AKI is an important marker of systemic hemodynamic vulnerability after aggressive postendovascular thrombectomy BP lowering.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04205305.

PMID:
42495732
Bibliographic data and abstract were imported from PubMed on 24 Jul 2026.

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