Blood Pressure Management After Successful Thrombectomy

Despite the success of endovascular therapy (EVT) in acute ischemic stroke due to large vessel occlusion, opportunities to further optimize clinical outcomes remain. One such avenue is to reduce hemorrhagic transformation in the infarcted tissue bed after successful reperfusion, which has been shown to be associated with worsened clinical outcomes. Because higher cerebral perfusion pressures may foster hemorrhagic transformation, it has been hypothesized that lowering systemic blood pressure (BP) after successful reperfusion could decrease cerebral hemorrhagic complications. Reducing systemic BP may also lead to a decrease in edema in the infarcted region and thus decrease final brain injury by reducing mass effect. Some, but not all, observational studies found that lower systolic BP in the hours after thrombectomy is associated with better clinical outcomes. Thus, intensive control of BP following endovascular therapy was proposed as a modifiable factor that may help further optimize outcomes.
Source: JAMA - Category: General Medicine Source Type: research