Intraparenchymal haemorrhages as a primary outcome measure

We read with interest the Article by Mikael Mazighi and colleagues,1Mazighi M Richard S Lapergue B et al.Safety efficacy of intensive bloaod pressure lowering after successful endovascular therapy in acute ischaemic stroke (BP-TARGET): a multicentre, open-label, randomised controlled trial.Lancet Neurol. 2021; 20: 265-274Summary Full Text PDF PubMed Scopus (20) Google Scholar who tested whether an blood regimen (target 100–129 mm Hg systolic) resulted lower rates radiographic intraparenchymal haemorrhage at 24–36 h compared standard care (130–185 within BP-TARGET trial. colleagues found no significant differences between two groups primary outcome measure haemorrhage. question relevance outcome, because definition any presumably included several small areas bleeding typical either petechial infarction or confluent categorised as haemorrhagic type 1 2, which usually involves portions entire infarct extent.2von Kummer R Broderick JP Campbell BC al.The Heidelberg Bleeding Classification: classification events ischemic reperfusion therapy.Stroke. 2015; 46: 2981-2986Crossref (331) The can improve functional outcomes was not adequately powered for use surrogate be problematic, especially if it does correlate well enough conventional clinical outcomes, such disability (eg, using modified Rankin Scale). presumed association is based on pathophysiological assumptions but, most studies, only more severe forms are associated worse outcomes. In post-hoc analysis ESCAPE-NA1 data, intracranial adjustment baseline characteristics volume, space-occupying parenchymal haemorrhages (parenchymal 2) were predictors decreased outcome.3Ospel JM Wu Q Menon BK al.Radiological patterns hemorrhage treatment stroke: results from Trial.Radiology. (published online June 1.)https://doi.org/10.1148/radiol.2021204560Crossref (3) Similarly, previous thrombolysis trial suggested that all severities, except 1, predicted outcome.4Dzialowski I Pexman JH Barber PA Demchuk AM Buchan Hill MD Asymptomatic may benign: prognosis Canadian alteplase effectiveness study registry.Stroke. 2007; 38: 75-79Crossref (131) BP-TARGET, 2 made up 15% radiographically confirmed bleeds, explicitly mentioned. More clarity reporting frequency each grade (haemorrhagic both would have been useful. investigators appropriately to detect difference when outcome. However, clinically meaningful definition, require much larger sample size due smaller expected difference. summary, we applaud authors their effort Although underpowered, similar Scale suggest unnecessary reperfusion. do choice haemorrhages, including types infarction, preferred meaningful, radiologically 2. declare competing interests. Safety trialAn systolic target did reduce 130–185 Hg. Notably, these applicable patients pressures than 130 end procedure. Further studies needed understand Full-Text Intraparenchymal – Authors' replyWe appreciate Mayank Goyal regarding trial.1 Their main concern relates defined haemorrhages.