Blood pressure status and recurrence risk after endovascular treatment of intracranial aneurysms: a systematic review and meta-analysis with narrative synthesis of blood pressure targets and hemodynamic evidence
- 1Jiangyin Clinical College, Xuzhou Medical University
Abstract
Background: Recurrence, recanalization, reperfusion, or retreatment remains an important durability limitation after endovascular treatment of intracranial aneurysms. Most recurrence studies characterize blood pressure exposure as a history or study-defined diagnosis of hypertension rather than achieved post-treatment systolic or diastolic blood pressure.
Objective: To quantify the association between study-defined/history-based hypertension status and recurrence-related outcomes after endovascular aneurysm treatment, and to separately summarize indirect clinical evidence on achieved blood pressure, blood pressure variability, and mechanistic hemodynamic evidence.
Methods: PubMed/MEDLINE, Ovid MEDLINE, and Embase were searched from database inception through April 2026. The direct recurrence synthesis included adult endovascular aneurysm cohorts reporting recurrence-related outcomes according to hypertension status. Indirect clinical studies of achieved blood pressure or blood pressure variability and mechanistic computational-fluid-dynamics studies were synthesized separately. Odds ratios (ORs) for the direct recurrence analysis were pooled using inverse-variance random-effects models with restricted maximum-likelihood estimation and Hartung-Knapp adjustment. Study selection was independently performed by two reviewers at title/abstract and full-text stages; unresolved disagreements were adjudicated by a third reviewer.
Results: Thirty-one studies were included. Eight studies provided extractable 2 × 2 data for the primary recurrence-related analysis (2,442 observations: 1,231 in the hypertension/high-BP-status group and 1,211 in the non-hypertension group; 559 recurrence-related events overall, 242 and 317 respectively). Study-defined hypertension showed a directionally higher but statistically non-significant association with recurrence/recanalization/reperfusion (OR 1.36, 95% CI 0.92–2.00; p = 0.104; I ² = 31.4%). No eligible recurrence study reported recurrence according to achieved SBP/DBP target categories. The overlapping full and matched Lee 2021 controlled-versus-uncontrolled hypertension estimates were presented separately and were not pooled. BP-variability studies addressed heterogeneous clinical outcomes and were not quantitatively pooled.
Conclusion: Current evidence is insufficient to establish study-defined hypertension as an independent predictor of recurrence after endovascular aneurysm treatment or to recommend a recurrence-preventive blood pressure target. The available direct evidence concerns predominantly history-based hypertension status, whereas achieved blood pressure and blood pressure variability evidence is indirect for angiographic recurrence.
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BibTeX
@article{pan2026blood,
title = {{Blood pressure status and recurrence risk after endovascular treatment of intracranial aneurysms: a systematic review and meta-analysis with narrative synthesis of blood pressure targets and hemodynamic evidence}},
author = {Weiyuan Pan and Yu Xu and Heng Gao},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1928054},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1928054/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Blood pressure status and recurrence risk after endovascular treatment of intracranial aneurysms: a systematic review and meta-analysis with narrative synthesis of blood pressure targets and hemodynamic evidence
AU - Weiyuan Pan
AU - Yu Xu
AU - Heng Gao
PY - 2026
DA - 2026/10/26
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1928054
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1928054/full
AB - Background: Recurrence, recanalization, reperfusion, or retreatment remains an important durability limitation after endovascular treatment of intracranial aneurysms. Most recurrence studies characterize blood pressure exposure as a history or study-defined diagnosis of hypertension rather than achieved post-treatment systolic or diastolic blood pressure. Objective: To quantify the association between study-defined/history-based hypertension status and recurrence-related outcomes after endovascular aneurysm treatment, and to separately summarize indirect clinical evidence on achieved blood pressure, blood pressure variability, and mechanistic hemodynamic evidence. Methods: PubMed/MEDLINE, Ovid MEDLINE, and Embase were searched from database inception through April 2026. The direct recurrence synthesis included adult endovascular aneurysm cohorts reporting recurrence-related outcomes according to hypertension status. Indirect clinical studies of achieved blood pressure or blood pressure variability and mechanistic computational-fluid-dynamics studies were synthesized separately. Odds ratios (ORs) for the direct recurrence analysis were pooled using inverse-variance random-effects models with restricted maximum-likelihood estimation and Hartung-Knapp adjustment. Study selection was independently performed by two reviewers at title/abstract and full-text stages; unresolved disagreements were adjudicated by a third reviewer. Results: Thirty-one studies were included. Eight studies provided extractable 2 × 2 data for the primary recurrence-related analysis (2,442 observations: 1,231 in the hypertension/high-BP-status group and 1,211 in the non-hypertension group; 559 recurrence-related events overall, 242 and 317 respectively). Study-defined hypertension showed a directionally higher but statistically non-significant association with recurrence/recanalization/reperfusion (OR 1.36, 95% CI 0.92–2.00; p = 0.104; I ² = 31.4%). No eligible recurrence study reported recurrence according to achieved SBP/DBP target categories. The overlapping full and matched Lee 2021 controlled-versus-uncontrolled hypertension estimates were presented separately and were not pooled. BP-variability studies addressed heterogeneous clinical outcomes and were not quantitatively pooled. Conclusion: Current evidence is insufficient to establish study-defined hypertension as an independent predictor of recurrence after endovascular aneurysm treatment or to recommend a recurrence-preventive blood pressure target. The available direct evidence concerns predominantly history-based hypertension status, whereas achieved blood pressure and blood pressure variability evidence is indirect for angiographic recurrence.
SN - 1664-2295
ER -