Periprocedural management of acute ischemic stroke patients undergoing endovascular therapy

Abstract

The physiologic derangements in acute stroke victims are dynamic. As noted extensively in the literature, there is mounting evidence to support that patients with large strokes, measured clinically through NIH Stroke Scale (NIHSS)1 or by radiologic methods,2 have increased mortality and are severely ill. Endovascular treatment of ischemic strokes inherently imposes a host of physiologic changes. Changes in cerebral perfusion and cerebral autoregulation need adequate hemodynamic support. Unintentionally induced changes during general anesthesia and potential hyperperfusion injury after revascularization may cause adverse outcomes. The loss of blood–brain barrier integrity poses additional challenges to antiplatelet and anticoagulant regimen. The primary goal of critical care management is to cater to the constantly changing cerebral perfusion in the background of loss of cerebral autoregulation. The practice remains varied in the community, administered by intensivists, anesthesiologists, and sometimes neurointerventional physicians. The individual and collective merits and demerits of current practice are unknown and have to be evaluated systematically. Admittedly, there exists no Class Ia evidence, and it is difficult …