Blood Pressure Management Following Large Vessel Occlusion Strokes: A Narrative Review

Abstract

Stroke is one of the leading causes of morbidity and mortalityworldwide. Intravenous tissue plasminogen activator and mechanicalthrombectomy comprise the two major treatments for acute ischemicstroke. Tissue plasminogen activator has been used for more than twodecades and guidelines for hemodynamic management followingtissue plasminogen activator administration are well established.However, mechanical thrombectomy is a relatively newer therapy andthere is a paucity of evidence regarding hemodynamic managementfollowing large vessel occlusion strokes. The important tenetsguiding the pathophysiology of large vessel occlusion strokes includeunderstanding of cerebral autoregulation, collateral circulation, andblood pressure variability. In this narrative review, we discuss thecurrent American Heart Association-American Stroke Associationguidelines for the early management of acute ischemic stroke duringdifferent phases of the illness, encountered at different sections of ahospital including the emergency room, the neuro-interventional suite,and the intensive care unit. There is emerging evidence with regardto post-recanalization blood pressure management following largevessel occlusion strokes. Future research directions will include realtime blood pressure variability assessments, identifying the extent ofimpaired autoregulation, and providing guidelines related to rangeand personalized blood pressure trajectories for patients followinglarge vessel occlusion strokes.