Post-thrombectomy management of the ELVO patient: Guidelines from the Society of NeuroInterventional Surgery

Intensive Care Management Following Endovascular Clot Retrieval for Acute Stroke: A Systematic Review of the Literature

“…The search for clinical practice guidelines included all major local and international societies for critical care, interventional neuroradiology, and stroke and identified 14 guidelines for inclusion. [22][23][24][25][26][27][28][29][30][31][32][33][34][35] Of these, two were specifically aimed at management following ECR. 26,30 The majority of identified guidelines focused on the management of the broader acute stroke population, with few specifically examining the post ECR patient population.…”

“…Guidelines from The Society of Neurointerventional Surgery recommend hemodynamic augmentation in patients with failed or incomplete recanalization following ECR. 26 They recommend maintaining a mean arterial pressure 10 to 20% above the baseline BP, while keeping the systolic blood pressure to a maximum of 185 mm Hg if intravenous (IV) tissue plasminogen activator (rtPA) has been administered. 26 These guidelines do not provide specific recommended targets in those who have been successfully recanalized.…”

“…26 These guidelines do not provide specific recommended targets in those who have been successfully recanalized. 26…”

“…Patient positioning can improve cerebral perfusion by increasing cerebral blood flow by as much as 15 to 20%. 26 It is suggested by two society guidelines to maintain a supine position unless there are concerns regarding risk of aspiration 26 or increased intracranial pressure (ICP) in patients with large hemispheric infarcts. 22…”

“…Barbiturates and steroids are not recommended. 23,24,26 Neurosurgical opinion should be sought early for a possible neurosurgical intervention. 23,24 Decompressive craniotomy has been extensively debated in the literature 43,44 and may improve mortality at the cost of functional outcome.…”