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Front. Neurol. | doi: 10.3389/fneur.2019.00138

Management of Blood Pressure During and After Recanalization Therapy for Acute Ischemic Stroke

  • 1University of California, San Francisco, United States

Ischemic stroke is a common neurologic condition and can lead to significant long term disability and death. Observational studies have demonstrated worse outcomes in patients presenting with the extremes of blood pressure as well as with hemodynamic variability. Despite these associations, optimal hemodynamic management in the immediate period of ischemic stroke remains an unresolved issue, particularly in the modern era of revascularization therapies. While guidelines exist for BP thresholds during and after thrombolytic therapy, there is substantially less data to guide management during mechanical thrombectomy. Ideal blood pressure targets after attempted recanalization depend both on the degree of reperfusion achieved as well as the extent of infarction present. Following complete reperfusion, lower blood pressure targets may be warranted to prevent reperfusion injury and promote penumbra recovery however prospective clinical trials addressing this issue are warranted.

Keywords: Acute ischemic stroke, cerebral autoregulation, Hypertension, Ischemic Penumbra, Embolectomy

Received: 16 Aug 2018; Accepted: 04 Feb 2019.

Edited by:

Fernando Testai, University of Illinois at Chicago, United States

Reviewed by:

Wengui Yu, University of California, Irvine, United States
Vincent Thijs, Florey Institute of Neuroscience and Mental Health, Australia  

Copyright: © 2019 Vitt, Trillanes and Hemphill. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Jesse C. Hemphill, University of California, San Francisco, San Francisco, 94143, California, United States, claude.hemphill@ucsf.edu