Periprocedural management of acute ischemic stroke intervention

Tarlov, Nicholas; Nien, Yih Lin; Zaidat, Osama O.; Nguyen, Thanh N.

doi:10.1212/wnl.0b013e31826958d3

Cited by 23 publications

(12 citation statements)

References 85 publications

(68 reference statements)

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“…Conversely, permissive hypertension may be beneficial in patients with non-recanalized LVO (nrLVO) by maintaining adequate brain perfusion pressure 12. Additionally, aggressive BP reduction in the first 24 hours of ictus has been associated with poor outcomes 15.…”

Section: Introductionmentioning

confidence: 99%

Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients

Goyal

Tsivgoulis

Pandhi

et al. 2018

J NeuroIntervent Surg

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Section: Introductionmentioning

confidence: 99%

Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients

Goyal

Tsivgoulis

Pandhi

et al. 2018

J NeuroIntervent Surg

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“…A U-shaped relationship between BP and functional outcome in patients treated with EVT has been reported [20,21]. Aggressive BP reduction in the first 24 h after EVT has been associated with poor outcomes [21], and in order to maintain adequate brain perfusion pressure, permissive hypertension may be beneficial in nonrecanalized patients [22]. In 2016, a cohort study of 255 patients with severe traumatic brain injuries showed that the rate of poor prognosis was higher in the MCA blood flow deceleration group (MFV <35 cm/s; EDV < 20 cm/s; PI > 1.4 shown by TCD) than in the normal MCA blood flow group (100.0 vs. 19.3%, p = 0.000) [23].…”

Section: Raising Bp Under Tcd Monitoringmentioning

confidence: 99%

Controlling Blood Pressure Under Transcranial Doppler Guidance after Endovascular Treatment in Patients with Acute Ischemic Stroke

Chen

et al. 2020

Cerebrovasc Dis

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Objective: This study aimed to control blood pressure (BP) under transcranial Doppler (TCD) guidance in patients with anterior circulation acute ischemic stroke after endovascular treatment (EVT) to reduce the incidence of early neurological deterioration (END) and improve neurological prognosis. Methods: This prospective randomized controlled study included 95 patients who were randomly divided into a TCDguided BP control (TBC) group and a non-TCD-guided BP control (NBC) group. The patients were monitored by TCD within 72 h after EVT. In the TBC group, BP decreased, BP increased, or intracranial pressure decreased when TCD showed blood flow acceleration, deceleration, or intracranial hypertension respectively. The BP of the NBC group was controlled according to the guidelines. The incidence of END and the prognosis was compared between the 2 groups. Results: TCD identified 18 patients with blood flow acceleration, but the prognosis of the 2 groups was not significantly different. TCD identified 23 patients with blood flow deceleration, and the poor prognosis rate at discharge was lower in the TBC group than in the NBC group (45.5 vs. 91.7%, p = 0.027). TCD identified 34 patients with intracranial hypertension, and the 3-month mortality rate of the TBC group was lower than that of the NBC group (0 vs. 36.8%, p = 0.011). The incidence rates of END and 3-month mortality in the TBC group were lower than those in the NBC group (13.8 vs. 37.5%, p = 0.036; 0 vs. 25.0%, p = 0.012) when TCD parameters were abnormal. Multivariable logistic regression analysis showed that the TBC group (adjusted OR 0.267, 95% CI 0.074-0.955; p = 0.042) was an independent protective factor against the incidence of END when TCD parameters were abnormal. Conclusion: These findings indicated that TCDguided BP and intracranial pressure control improved the prognosis of patients with blood flow deceleration and intracranial hypertension.

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“…Verglichen mit der Vielzahl der Studien, die sich mit der präinterventionellen Patientenselektion unter Einsatz der modernen Bildgebung und den Rekanalisationstechniken beschäftigen, ist die Literatur über das periprozedurale Management der Patienten, die für eine endovaskuläre lokale Behandlung infrage kommen, eher übersichtlich [10].…”

Section: Periprozedurales Managementunclassified

Intubation und Sedierung bei der endovaskulären Therapie des akuten Hirninfarkts

Ahlhelm

2015

Radiologe

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In the past complex intracranial treatments demanded intubation and general anesthesia of the patient. With increasing rate of endovascular local treatment of acute stroke more and more neurointerventionalists report that recanalisation techniques can be performed in sedation of the patient without the need of additional intubation. Although prospective studies are lacking retrospective studies have shown that the risk of iatrogeneous vessel injuries without global anesthesia is not increased but outcomes in case of conscious sedations are better compared with intubation and general anesthesia.

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Periprocedural management of acute ischemic stroke intervention

Cited by 23 publications

References 85 publications

Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients

Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients

Controlling Blood Pressure Under Transcranial Doppler Guidance after Endovascular Treatment in Patients with Acute Ischemic Stroke

Intubation und Sedierung bei der endovaskulären Therapie des akuten Hirninfarkts

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