Abstract Number: Esoc2026lt47 Lt47 - A Randomized Trial on Hemodynamic Optimization of Cerebral Perfusion After Successful Endovascular Therapy in Patients With Acute Ischemic Stroke

Abstract Background and aims Intensive blood pressure (BP) lowering following endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) has not demonstrated benefit. The HOPE trial (NCT04892511) evaluated whether post-EVT recanalization-based systolic BP target ranges improved functional outcomes compared with standard management. Methods HOPE was an investigator-initiated, multicenter, randomized trial with open-label treatment and blinded endpoint assessment (March 2021-September 2025). Patients with anterior AIS who underwent EVT and achieved successful recanalization (mTICI≥2b) were randomized to protocol-driven or guideline-recommended BP management. The protocol defined two systolic BP target ranges according to final recanalization status (mTICI 2b: 140–160 mmHg; mTICI 2c/3: 100–140 mmHg). The intervention was applied for 72 hours and included antihypertensive or vasopressor therapies as needed. The primary outcome was favorable functional outcome at 90 days, defined as modified Rankin Scale (mRS) score 0–2. Results A total of 442 patients were enrolled and randomly assigned to intervention (n=217) or control (n=225). Mean age was 74 years and 53% were women. Median time within target range was 80% in the intervention group and 100% in the control group. At 90 days, 129 of 217 patients (59.5%) in the intervention group and 105 of 225 (46.7%) in the control group achieved favorable functional outcome (OR=1.68, 95%CI 1.15–2.44; p=0.007). Hemorrhagic transformation was lower in the intervention group (17% vs. 25%; p=0.045). Mortality was 15% in both arms (p=0.958). Conclusions In patients with AIS who achieved successful recanalization with EVT, a tailored BP target strategy based on recanalization status improved functional outcomes. Conflict of interest