Abstract 063: A Scoping Review of Drug‐Induced Hypertension in the Endovascular Thrombectomy Era

IntroductionSince 2015, endovascular thrombectomy (EVT) has become the gold standard for treating large vessel occlusion acute ischemic stroke (LVO‐AIS). Drug‐induced hypertension (DIH) shows promise in enhancing collateral blood flow to the ischemic penumbra, particularly in LVO‐AIS patients with larger penumbral tissue volumes compared to other stroke subtypes. Despite its potential, current AIS guidelines lack specific recommendations regarding the use of DIH in patients undergoing recanalization therapy. This review aims to provide a comprehensive analysis of the existing evidence on DIH in AIS within the context of the EVT era.MethodsWe conducted a comprehensive search of five electronic databases, supplemented by gray literature, to identify studies on DIH in AIS between 2015 and 2024. Data extraction focused on key variables including study design, patient population, target blood pressure (BP), pharmacological agents used, dosage, timing and duration of intervention, recanalization strategies (intravenous thrombolysis, EVT), DIH's impact on outcomes, and associated adverse effects.ResultsSeven studies were identified, with sample sizes ranging from 50 to 218 participants (median: 136). Of these, four were retrospective, and three were randomized controlled trials. Two studies focused on patients with lacunar stroke, two on patients with early neurological deterioration, and three on a broader AIS subpopulation. Three studies specifically targeted patients ineligible for recanalization therapy, three included a mixed population of both recanalization and non‐recanalization patients, and only one exclusively studied patients eligible for EVT. Notably, none of the studies involving recanalization therapy detailed the timing of DIH initiation relative to the therapy. The most common target BP was a 20% increase from baseline systolic BP (observed in 4/7 studies). Phenylephrine infusion was the most frequently used agent (4/7 studies), followed by norepinephrine (2/7 studies). Four studies reported achieving primary efficacy outcomes of DIH, including improved functional status and early neurological improvement. Safety outcomes and adverse effects were not associated with DIH in three of the four studies that evaluated these factors.ConclusionThe current evidence on DIH for AIS in the EVT era remains inconclusive, particularly concerning its benefit in patients undergoing revascularization therapy. Although achieving a 20% increase in baseline systolic