Intraparenchymal haemorrhages as a primary outcome measure – Authors' reply

We appreciate the interest of Mayank Goyal and colleagues regarding BP-TARGET trial.1Mazighi M Richard S Lapergue B et al.Safety efficacy intensive blood 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 Their main concern relates to primary outcome, defined as all intraparenchymal haemorrhages. was designed 2015 proof-of-concept trial. At that time, with advent therapy, reperfusion rates dramatically increased, numerous questions remained unanswered medical management prevent possible injuries. agree type 1 2 parenchymal haemorrhages are more commonly associated worse outcomes; however, several studies have underlined deleterious effect haemorrhagic infarction 2.2Hao Y Liu W Wang H al.Prognosis asymptomatic intracranial hemorrhage treatment.J Neurointerv Surg. 2019; 11: 123-126Crossref (13) Scholar, 3Maïer Desilles JP Mazighi Intracranial therapies ischemic patients.Front 2020; 11599908Crossref (8) The modified Rankin Scale score is simple validated endpoint, but it remains an inaccurate imprecise endpoint fully neurological outcomes (eg, gait or cognitive impairment). Haemorrhagic could on overall outcome; this not captured by Scale. For reason, we believe inclusion can give new insights into patients who had therapy. Beyond association withoutcome, latter lesions might substantially change (ie, there wide range haemorrhage types, possibly limiting initiation antithrombotic treatments therapy). With perspective strategies be tested improve reperfusion, question whether strategy becomes highly relevant. debate considering haemorrhages), trial has highlighted important issues field, especially for future trials. instance, which modality should used monitor phase invasive not), threshold targeted (lower individualised)? More importantly, prognostic marker rather than therapeutic target? As trials will consider provide complementary additional answer these questions. MM declares consulting activities Boehringer Ingelheim, Amgen, Air Liquide, Acticor Biotech. All other authors declare no competing interests. Safety trialAn systolic target 100–129 mm Hg did reduce radiographic at 24–36 h compared standard care 130–185 Hg. Notably, results applicable pressures 130 end procedure. Further needed understand between reperfusion. Full-Text Intraparenchymal outcome measureWe read Article Mikael colleagues,1 regimen (target systolic) resulted lower (130–185 within found significant differences two groups measure haemorrhage.