Management of Blood Pressure for Endovascular Stroke Treatment

In this chapter, we discuss periprocedural blood pressure (BP) management during and early after endovascular stroke treatment (EST). It comes as a natural continuation with the previous chapters for BP management at the time of acute stroke treated with thrombolysis. The potential difference in both situations—intravenous thrombolysis and EST—comes from the low reperfusion rate in the first case and that mechanical restoration of blood flow in the second case is not equivalent to restoration of blood flow to the ischemic region, and that optimal BP management may aid in the preservation of flow. It should be stressed that strict BP control for thrombolysis is hot point in terms of medication licensing and the fact that changes in BP are more rapid with EST. There is still a great debate and uncertainty what is the proper BP control in the different post-EST scenarios. The current concept based on non-interventional treatment trials for no or slight lowering of BP is changing toward rapid lowering to a certain target value, which is determined by the reperfusion success and the corresponding vital brain tissue. This is enabled by the rapidly evolving neuroimaging indices.