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Updated: Oct 13, 2025
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Periprocedural Management During Stroke Thrombectomy
Claus Z Simonsen1, Julian Bösel2, Mads Rasmussen2
1From the Department of Neurology (C.Z.S.) and Department of Anesthesia (M.R.), Section of Neuroanesthesia, Aarhus University Hospital, Aarhus, Denmark; and Department of Neurology (J.B.), Klinikum Kassel, Germany. clasim@rm.dk.
Neurology
|November 17, 2021
Summary
Optimizing periprocedural care, including IV tissue plasminogen activator (tPA) and anesthesia, improves outcomes for endovascular therapy (EVT) in acute ischemic stroke. Careful management of blood pressure and ventilation is crucial for successful reperfusion.
Area of Science:
- Neurology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Endovascular therapy (EVT) is a key treatment for acute ischemic stroke due to large vessel occlusion, aiming for reperfusion and improved neurological outcomes.
- Current research focuses on optimizing EVT procedures to maximize patient benefits.
Purpose of the Study:
- To review current literature on periprocedural care in EVT for acute ischemic stroke.
- To examine the impact of pretreatment with IV tissue plasminogen activator (tPA), anesthesia choice, ventilation strategy, and blood pressure management on outcomes.
Main Methods:
- Literature review of current studies on periprocedural stroke care.
- Analysis of meta-analyses and available evidence regarding specific interventions.
Main Results:
- Intravenous tPA should not be withheld for eligible EVT patients.
- General anesthesia, particularly with dedicated neuroanesthesia teams, shows better neurologic outcomes than procedural sedation.
- Maintain systolic blood pressure >140 mm Hg during EVT and <160 mm Hg post-reperfusion; avoid extreme deviations in normoxemia and normocapnia in ventilated patients.
Conclusions:
- Periprocedural care significantly impacts outcomes following EVT for large vessel ischemic stroke.
- Further prospective studies are essential to fully optimize periprocedural strategies.
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