Abstract:Objective To evaluate the safety and effectiveness of intensive blood pressure management after endovascular treatment (EVT) in patients with acute ischemic stroke (AIS). Methods The studies on intensive blood pressure management after EVT, in patients with AIS, were searched in PubMed, Embase, Web of Science, CNKI, and Wanfang Database, up to April 2024. The primary outcome was functional independence at 3 months after stroke ［modified Rankin Scale (mRS): 0-2 points］. Secondary outcomes included good functional recovery (mRS: 0-1 points), severe disability (mRS: 3-5 points), and death or disability (mRS: 3-6 points). The two primary safety outcomes included the incidence of death related to stroke within 3 months and the incidence of symptomatic intracranial hemorrhage (sICH) within 36 hours. Results Among 1 739 patients in six randomized controlled trials, compared with the routine blood pressure management group, intensive blood pressure management did not significantly improve functional independence (RR=0.92, 95%CI: 0.76-1.11; I2= 70%, P=0.39). Conversely, intensive blood pressure reduction decreased functional recovery (RR=0.87, 95%CI: 0.76-0.99; I2=11%, P=0.03)， increased the risks of severe disability (RR=1.42, 95%CI: 1.21-1.68; I2=0%, P<0.01), death or disability(RR=1.12, 95%CI: 1.00-1.24; I2=17%, P=0.04), and there was no significant diffence in the risk of sICH within 36 hours (RR=1.07, 95%CI: 0.75-1.54; I2=0%, P=0.70), and death related to stroke within 3 months (RR=1.13, 95%CI: 0.88-1.45; I2=0%, P=0.33).Conclusion Intensive blood pressure management after EVT in patients with AIS does not improve the incidence of functional independence and good prognosis, but increases the risks of severe disability, death or diabilily. Therefore, the benefits of intensive blood pressure management after EVT in patients with AIS stroke are limited.