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Comment & Response
October 12, 2020

Blood Pressure Thresholds During Endovascular Therapy in Ischemic Stroke

Author Affiliations
  • 1Division of Critical Care Neurology, Brigham and Women’s Hospital, Boston, Massachusetts
JAMA Neurol. 2020;77(12):1578-1579. doi:10.1001/jamaneurol.2020.3816

To the Editor We read with interest the article by Rasmussen et al1 associating blood pressure (BP) thresholds and neurologic outcomes after endovascular therapy for acute ischemic stroke. Although a case might be made for a floor threshold of mean arterial BP (MABP) of 70 mm Hg, we question the authors’ conclusion that the outcomes of the Sedation vs Intubation for Endovascular Stroke Treatment (SIESTA), Anesthesia During Stroke (ANSTROKE), and General or Local Anesthesia in Intra-Arterial Therapy (GOLIATH) trials argue for an MABP of 90 mm Hg as a ceiling threshold for targeting procedural BP. Concerning the potential harm of high procedural BPs, the authors conclude, “Critical MABP thresholds and durations for poor outcome were found to be…MABP greater than 90 mm Hg for more than 45 minutes…with a number needed to harm of 10 patients.”1(p1)

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