{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T21:26:13Z","timestamp":1790889973307,"version":"4.1.0"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Cerebral swelling in relation to cytotoxic edema is a predictor of poor outcome in acute ischemic stroke (AIS) and elevated blood pressure (BP) promotes its development. Whether intensive BP-lowering treatment reduces cerebral swelling is uncertain. We aimed to determine whether intensive BP lowering reduces the severity of cerebral swelling after thrombolysis for AIS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>A secondary analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study), a partial factorial, international, multicenter, open-label, blinded end point, randomized controlled trial of alteplase dose and levels of BP control in thrombolyzed patients with AIS. Participants were randomly assigned to intensive (systolic target 130\u2013140 mm\u2005Hg within 1 hour; maintained for 72 hours) or guideline-recommended (systolic target &lt;180 mm\u2005Hg) BP management. Available serial brain images (baseline and follow-up, computed tomography, or magnetic resonance imaging) were centrally analyzed with standardized techniques (Apollo MIStar software) by expert readers blind to clinical details to rate swelling severity (from 0 no to 6 most severe swelling [midline shift and effacement of basal cisterns]) and other abnormalities. Primary outcome was any cerebral swelling (score, 1\u20136) in logistic regression models.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Of 1477\/2196 (67.3%) patients (mean age, 67.7 years; female, 39.6%) with sequential scans, the between-group mean systolic BP difference was 6.6 mm\u2005Hg over 24 hours. No significant difference was found in the treatment effect on any cerebral swelling between intensive and guideline-recommended BP management (22.12% versus 22.39%, adjusted odds ratio, 1.05 [95% CI, 0.81\u20131.36];\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              =0.71). Results were consistent across different groups of swelling severity (swelling score 2\u20136, 3\u20136, and 4\u20136; and ordinal shift on swelling score).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Modest early intensive BP lowering does not seem to alter cerebral swelling in thrombolyzed patients with AIS. Further research is needed to quantify brain edema to allow a better understanding of the complex relations of BP and outcomes from AIS.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT01422616.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/strokeaha.124.049938","type":"journal-article","created":{"date-parts":[[2025,4,3]],"date-time":"2025-04-03T10:48:39Z","timestamp":1743677319000},"page":"1388-1395","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Effects of Intensive Blood Pressure Lowering on Brain Swelling in Thrombolyzed Acute Ischemic Stroke: The ENCHANTED Results"],"prefix":"10.1161","volume":"56","clinical-trial-number":[{"clinical-trial-number":"nct01422616","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Guobin","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Radiology, Shanghai Sixth People\u2019s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, China (G.Z.)."},{"name":"The George Institute for Global Health China, Beijing (G.Z., C.C., Y.Z., L.Z., C.S.A., L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8960-8797","authenticated-orcid":true,"given":"Chen","family":"Chen","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health China, Beijing (G.Z., C.C., Y.Z., L.Z., C.S.A., L.S.)."},{"name":"Neurology Department, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China (C.C., G.L.)."},{"name":"The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.C., X.R., Y.Z., M.O., L.B., Q.L., X.W., S.O., L.L., X.C., C.S.A., L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5235-894X","authenticated-orcid":true,"given":"Xinwen","family":"Ren","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.C., X.R., Y.Z., M.O., L.B., Q.L., X.W., S.O., L.L., X.C., C.S.A., L.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Zhao","sequence":"additional","affiliation":[{"name":"The George Institute for Global Health China, Beijing (G.Z., C.C., Y.Z., L.Z., C.S.A., L.S.)."},{"name":"The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.C., X.R., Y.Z., M.O., L.B., Q.L., X.W., S.O., L.L., X.C., C.S.A., 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