HOPE Trial: Personalized Blood Pressure After Stroke Clot Removal Boosts Recovery
A landmark clinical trial has found that tailoring blood pressure targets to the degree of brain reperfusion after mechanical thrombectomy significantly improves functional recovery in stroke patients without increasing safety risks.
Key Findings
The HOPE (Hemodynamic Optimization of Cerebral Perfusion after Endovascular Therapy) trial was led by the Sant Pau Research Institute (IR Sant Pau) and included 440 patients across 11 Spanish hospitals.
- Patients were randomly assigned to either conventional blood pressure management or a strategy customized to their reperfusion status.
- Those with near-complete or complete reperfusion received lower blood pressure targets; those with incomplete reperfusion had higher targets.
- At 90 days, 60.0% of the intervention group achieved functional independence versus 47.1% in the control group—an absolute difference of 13.3 percentage points.
- The intervention group also had a lower incidence of hemorrhagic transformation, with no increase in mortality or serious complications.
Background
Mechanical thrombectomy can successfully restore blood flow in large-vessel occlusion stroke, yet roughly half of patients with successful angiographic reperfusion still do not achieve satisfactory functional recovery—a phenomenon known as clinically ineffective reperfusion.
Contributing factors include reperfusion injury, microcirculatory dysfunction, loss of cerebral autoregulation, and hemorrhagic transformation. Prior trials of uniform intensive blood pressure reduction showed inconsistent benefits.
The HOPE trial introduced a physiology-based approach, recognizing that hemodynamic management should be individualized based on reperfusion status.
Statements from Investigators
“Until now, we have applied fairly uniform strategies after thrombectomy, but probably not all patients need the same approach. Our results suggest that adjusting blood pressure according to the degree of reperfusion can have a direct impact on recovery.”
— Dr. Pol Camps-Renom, head of the Cerebrovascular Diseases Research Group at IR Sant Pau and study coordinator
“We have shown that it is possible to improve patient recovery without adding risk. This balance between efficacy and safety is probably one of the most relevant aspects of the findings.”
— Dr. Joan Martí-Fàbregas
Implications
The results were presented at the European Stroke Organisation conference and published in JAMA Neurology. They suggest a paradigm shift toward individualized blood pressure control after thrombectomy.
The trial was stopped before reaching the planned sample size, so additional studies are needed to confirm findings before broad clinical adoption.