Tailoring blood pressure to the patient during thrombectomy did not help

The edition in brief

DETERMINE tested whether holding mean arterial pressure within 10% of each patient's own pre-thrombectomy value beat the standard systolic band of 140 to 180 mmHg. In 433 patients with anterior large vessel occlusion at eight French centres, favourable outcome at 90 days was 44.2% with individualised control and 48.8% with standard control (adjusted OR 0.82, 95% CI 0.54 to 1.24). Achieved pressures did not actually differ between the arms, which limits what the null result proves about the strategy. A Chinese randomised trial in 334 patients with high-risk non-disabling ischaemic cerebrovascular events compared low-dose ticagrelor 60 mg twice daily plus aspirin with clopidogrel plus aspirin: early neurological deterioration within seven days fell from 22.2% to 10.8% (RR 0.55, 0.33 to 0.92), excellent functional outcome at 90 days rose from 80.8% to 92.8%, and bleeding, all mild, did not differ. It is open-label with a subjective primary endpoint, in a population where CYP2C19 loss-of-function alleles are common. A meta-analysis of nine trials and 334 participants found cannabinoids did not improve agitation on the Cohen-Mansfield inventory (SMD −0.58, −1.71 to 0.55, I² 84%) or neuropsychiatric symptoms, with somnolence doubled (RR 2.03, 1.29 to 3.20); certainty was moderate for behaviour, low for cognition. The FDA has classified a second Class II recall of 200 mg carbamazepine tablets, this one manufactured by Taro and recalled by Sun Pharmaceutical Industries Inc, for black spots from burnt excipient. And a meta-analysis of seven randomised trials in 1,889 patients found middle meningeal artery embolisation added to standard treatment cut recurrent or residual chronic subdural haematoma (RR 0.63, 0.46 to 0.85) and reoperation (RR 0.39, 0.28 to 0.56) without raising serious adverse events, with benefit apparently independent of timing.