The optimal blood pressure (BP) management following successful endovascular treatment (EVT) in acute ischaemic stroke (AIS) patients remains unclear. This study investigated the safety and efficacy of intensive BP control in AIS patients who had received EVT within 6 h. This randomised, multicentre, open-label, blinded-endpoint clinical trial (ChiCTR2200057770) was conducted at 63 stroke centres in China. Eligible participants had AIS due to large vessel occlusion in anterior circulation, underwent EVT within 6 h, and achieved successful recanalisation. Patients were randomised to intensive (systolic BP target <130 mm Hg) or standard (systolic BP target <180 mm Hg) management, maintained until 24 h post-EVT. The primary outcome was unfavourable functional outcome (modified Rankin Scale score of 3–6) at 90 days. The trial was terminated following a neutral interim analysis results and publication of counterpart randomised trials. Between October 14, 2022 and March 18, 2024, 383 patients were randomised. Unfavourable functional outcome occurred in 71.0% (130/183) of the intensive-management group and 67.5% (135/200) of the standard-management group (risk ratio, 1.05; 95% CI, 0.92–1.20; p = 0.45). There was no significant difference in symptomatic intracerebral haemorrhage, malignant brain oedema, or all-cause death at 90 days. Intensive BP management to <130 mm Hg did not improve outcomes in AIS patients undergoing EVT within 6 h and achieved successful recanalisation. The optimal BP management strategies require further investigation. Sichuan University West China Hospital, 10.13039/501100001809 National Natural Science Foundation of China , National Key R&D Programme of China, and 10.13039/501100004829 Science and Technology Department of Sichuan Province .

Increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH) affects the retinal microvasculature, which can be imaged and quantified by optical coherence tomography angiography (OCTA). We aimed to identify the mediating factor between ICP and OCTA parameters association in IIH patients. IIH patients with active intracranial hypertension were enrolled. OCTA imaging was performed after ICP measurement. We quantified the branching complexity of the retinal arterioles and venules from the superficial vascular complex of the OCTA image. Eyes of IIH patients were stratified into eyes with papilledema (IIH-P) and eyes without papilledema (IIH-WP). All participants underwent visual acuity (VA) examination. One hundred and thirty-eight eyes from 70 IIH patients and 146 eyes from 73 controls were included. Compared to the control group, IIH patients and IIH-P had reduced arteriole complexity and increased venule complexity (p < 0.05). For IIH patients and IIH-P, increased retinal venule complexity correlated with increased ICP and reduced VA (p < 0.05); while decreased arteriole complexity only correlated with Frisen scores (p = 0.026). Papilledema mediated the effect (p < 0.001) between ICP and arteriole complexity while ICP had a direct effect (p < 0.001) on venule complexity. Retinal venules imaged via OCTA may reflect ICP levels and may underpin the direct effect of increased ICP in IIH patients.