Could lowering a patients blood pressure after treatment for an ischemic stroke be a safe way to open the door to better outcomes?
Researchers led by the University of Cincinnati’s Eva Mistry are seeking to answer this through the means of Blood Pressure After Endovascular Stroke Therapy-II (BEST-II) clinical trial.
Study Background
The initial idea explained by Misty, MD, that lead to this study, started when she was a second-year medical resident at Houston Methodist Hospital in 2015. This is around the same time when a new acute stroke treatment was being studied and introduced.
That treatment being, end-vascular thrombectomy, a minimally invasive procedure, that involves using a catheter to remove a blood clot from a blood vessel in the brain for stroke patients.
After receiving this treatment, patients would be transferred to intensive care units, on which Mistry would be on call overnights providing care.
A main aspect of treating patients in the care units was to monitor and control their blood pressure. Mistry recollects that high blood pressure following a stroke is associated with additional risks of bleeding.
However, there was also concern that by lowering the blood pressure too much, that it would not provide enough blood flow to the area of the brain where the stroke occurred.
Mistry, assistant professor in the Department of Neurology and Rehabilitation medicine in UC’s College of Medicine and a UC Health physician, said that “we didn’t really have any data to guide us.”
“That’s when that question came to my mind as to what is the relationship of blood pressure in the ICU with the outcomes of stroke patients treated with thrombectomy.”
Mistry helped lead an expansive observational study at the University of Cincinnati, which looked to identify which exact blood pressure targets are associated with better or worse outcomes following thrombectomy procedures.
The research from this study determined:
“A systolic blood pressure of 160 millimetres of mercury was a dividing line, with lower blood pressures associated with better outcomes and higher blood pressures associated with worse outcomes.”
Study Design
“The BEST-II study is a randomised trial seeking to understand if lowering blood pressure is safe for patients. In the trial, 120 patients who underwent thrombectomy procedures to treat an acute stroke were assigned into one of three treatment groups.”
Each of the treatment groups had a different target for their systolic blood pressure.
Group 1: systolic blood pressure of less than 140 mm
Group 2: systolic blood pressure of less than 160 mm
Group 3: systolic blood pressure of less than or equal to 180 mm
Mistry noted that if the lower blood pressure targets were to be found unsafe, that it would be important to hastily share the data, as there are numerous different targets currently set by stroke physicians across the US.
The BEST-II study is the first where Mistry has served as the national principal investigator for a randomised clinical trial. Under her leadership, enrolment for the study was completed before schedule. Mistry’s colleague and a professor of neurology, Pooja Khatri, MD, complimented Mistry’s dedication to advancing stroke care for her patients and that she strives to think creatively and collaboratively to help patients.
“It’s a testament to her team-building and leadership skills and her ability to create a pragmatic and doable trial,” Khatri said. “What is particularly remarkable is that Mistry has all of these accomplishments while also growing a young and beautiful family and being a kind and generous colleague.”
Emerging Leadership
Additionally to leading BEST -II, Mistry was a recent invitee attendant at the National Academy of Medicine (NAM) Emerging Leaders Forum in Washington D.C. Those invited must be nominated by NAM members to attend the prestigious forum. Mistry was nominated by her mentor at UCLA Roger Lewis, MD.
The forum included discussions on implementing research in to practice, so that any discoveries made by researchers, the knowledge is shared with the community, thus improving patient care.
“In stroke research, we have seen several therapies take years and years to be implemented at community levels, either because clinicians are hesitant or patients are hesitant,” she said. “If I generate results, but if the practice changes never make it back to the community, it’s wasted time and resources. It was very eye opening for me to know that the implementation phase of the clinical research is so important.”
