Thursday, January 21, 2021

Blood Pressure Management Before, During, and After Endovascular Thrombectomy for Acute Ischemic Stroke

 Since no factual basis exists for blood pressure management post stroke, your doctor is just guessing. Hope she guesses right. Too high blood pressure and you could create a hemorrhage, too low means you aren't getting enough oxygen to those neurons in the penumbra that need it before they completely die.

Although there might be other ways to get more oxygen to your brain, don't listen to me, I'm not medically trained.

 Does your doctor know about them?

Possible solutions: Obviously not vetted coming from me. Don't do them. 

Normobaric oxygen (10)

How to Improve Your Brain Function with An Oxygen Concentrator April 2018 

Or is it more important to increase the loading ability of red blood cells to carry more oxygen? 

Like this?

University of Glasgow Study Demonstrates the Ability of Oxycyte® to Supply Oxygen to Critical Penumbral Tissue in Acute Ischemic Stroke  August 2012

Or like this?

chronic cannabis users have higher cerebral blood flow and extract more oxygen from brain blood flow than nonusers. August 2017   

Vinpocetine increases cerebral blood flow and oxygenation in stroke patients: a near infrared spectroscopy and transcranial Doppler study

The latest here:

Blood Pressure Management Before, During, and After Endovascular Thrombectomy for Acute Ischemic Stroke

Adam de Havenon
,
Nils Petersen
,
Ali Sultan-Qurraie
,
Matthew Alexander
,
Shadi Yaghi
,
Min Park
,
Ramesh Grandhi
,
Eva Mistry
› Author Affiliations
Zoom Image

Abstract

There is an absence of specific evidence or guideline recommendations on blood pressure management for large vessel occlusion stroke patients. Until randomized data are available, the periprocedural blood pressure management of patients undergoing endovascular thrombectomy can be viewed in two phases relative to the achievement of recanalization. In the hyperacute phase, prior to recanalization, hypotension should be avoided to maintain adequate penumbral perfusion. The American Heart Association guidelines should be followed for the upper end of prethrombectomy blood pressure: ≤185/110 mm Hg, unless post–tissue plasminogen activator administration when the goal is <180/105 mm Hg. After successful recanalization (thrombolysis in cerebral infarction [TICI]: 2b–3), we recommend a target of a maximum systolic blood pressure of < 160 mm Hg, while the persistently occluded patients (TICI < 2b) may require more permissive goals up to <180/105 mm Hg. Future research should focus on generating randomized data on optimal blood pressure management both before and after endovascular thrombectomy, to optimize patient outcomes for these divergent clinical scenarios.



Publication History

Publication Date:
20 January 2021 (online)

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