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Semin Neurol 2021; 41(01): 046-053
DOI: 10.1055/s-0040-1722721
Review Article

Blood Pressure Management Before, During, and After Endovascular Thrombectomy for Acute Ischemic Stroke

Adam de Havenon
1   Department of Neurology, University of Utah, Salt Lake City, Utah
,
Nils Petersen
2   Department of Neurology, Yale University, New Haven, Connecticut
,
Ali Sultan-Qurraie
3   Department of Neurology, University of Washington, Valley Medical Center, Seattle, Washington
,
Matthew Alexander
4   Department of Radiology, University of Utah, Salt Lake City, Utah
,
Shadi Yaghi
5   Department of Neurology, New York University, New York, New York
,
Min Park
6   Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
,
Ramesh Grandhi
7   Department of Neurosurgery, University of Utah, Salt Lake City, Utah
,
Eva Mistry
8   Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
› Author Affiliations
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Abstract

There is an absence of specific evidence or guideline recommendations on blood pressure management for large vessel occlusion stroke patients. Until randomized data are available, the periprocedural blood pressure management of patients undergoing endovascular thrombectomy can be viewed in two phases relative to the achievement of recanalization. In the hyperacute phase, prior to recanalization, hypotension should be avoided to maintain adequate penumbral perfusion. The American Heart Association guidelines should be followed for the upper end of prethrombectomy blood pressure: ≤185/110 mm Hg, unless post–tissue plasminogen activator administration when the goal is <180/105 mm Hg. After successful recanalization (thrombolysis in cerebral infarction [TICI]: 2b–3), we recommend a target of a maximum systolic blood pressure of < 160 mm Hg, while the persistently occluded patients (TICI < 2b) may require more permissive goals up to <180/105 mm Hg. Future research should focus on generating randomized data on optimal blood pressure management both before and after endovascular thrombectomy, to optimize patient outcomes for these divergent clinical scenarios.

Keywords

blood pressure - acute ischemic stroke - large vessel occlusion


Publication History

Article published online:
20 January 2021

© 2021. Thieme. All rights reserved.

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