Blood Pressure Target in Acute Stroke to Reduce hemorrhaGe After Endovascular Therapy

Comparison of Two Strategies for Blood Pressure Control in the Setting of Acute Ischemic Stroke to Reduce Cerebral Hemorrhage After Thrombectomy: Systolic Blood Pressure Target of Less Than 130 mmHg vs Less Than 185 mmHg, for 24 Hours Following Reperfusion, in Patients With Cerebral Infarction Due to Occlusion of the Anterior Circulation

A randomized, multicenter study comparing two strategies: 1 / standard management of systolic blood pressure according to international recommendations (systolic blood pressure <185 mm Hg) versus 2 / intensive blood pressure management Systolic with a target <130 mm Hg.

Patients will be followed for 3 months:

• inclusion after reperfusion: clinical evaluation with NIHSS (National Institute of Health Stroke Score) score, measurement of blood pressure.
• within 24 hours after reperfusion: blood pressure measurements
• at 24 hours: measurement of blood pressure (T0 + 24 h and evaluation of the NIHSS score.
• Between 24 and 36 hours :cerebral scan (assessment of hemorrhagic transformations and cerebral infarction volumes). For some centers: Cerebral MRI without injection between H24 and H36
• 72 hours after reperfusion: Cerebral scanner in case of hyperdensity on the initial scanner
• 3 months after reperfusion: disability assessment by Rankin score

Inclusion Criteria:

• Intracranial Occlusion of internal carotid arteries and/or proximal middle cerebral (segment M1) diagnosis made on initial Imaging.
• Reperfusion after a thrombectomy procedure (defined by a 2b-3 TICI score -Thrombolysis In Cerebral Infarction- score).

Exclusion Criteria:

• Per-procedure hemorrhagic complications (prior to reperfusion)
• Systolic blood pressure at baseline <130 mm Hg within one hour of recanalization
• Pre-existing stroke handicap defined by a Rankin score (modified scale, mRS)> 3
• Hemodynamically significant carotid stenosis
• Occlusion of the isolated cervical carotid artery
• Known pregnancy
• Legal protection
• Non-affiliation to a social security scheme
• Refusal of the patient (or of his / her relatives in case of urgent inclusion)