Background Five recent trials provided level 1 evidence for the benefit of mechanical thrombectomy in select patients presenting with acute ischemic stroke. With the expectation that endovascular intervention for acute ischemic stroke will be increasingly used, it is important to consider other factors that might further improve clinical outcome in these patients. One of these could potentially be how we manage blood pressure in the acute period following mechanical thrombectomy, for which there are currently no specific guidelines. The objective of this study was to investigate the consensus practices for the management of blood pressure post-mechanical thrombectomy via a web-based survey study.
Methods IRB approval was obtained for a 10 question web-based survey study. This questionnaire was distributed to a targeted group of physicians that included vascular neurologists, neurointensivists, and neurointerventionalists. A total of 88 complete responses were analyzed. Results: Responses were relatively well-distributed between vascular neurologists (26%), neurointensivists (31%), and neurointerventionalists (35%). Majority of responders were employed at comprehensive stroke centers (72%), saw >500 annual stroke admits (52%), and had access to endovascular stroke therapies (97%). A significant diversity in opinion was noted with regards to the main question of this study i.e. blood pressure management post-mechanical thrombectomy (Figure 1). Interestingly, this finding differed from the response to our final question, where the majority (59%) of responders did not believe that TICI 2 b versus TICI 3 vessel recanalization should influence optimal systolic blood pressure goals (Figure 2).
Conclusion This study shows a clear disparity of opinion with regard to blood pressure management following mechanical thrombectomy for acute ischemic stroke. Optimal blood pressure management following recanalization may play a role in improving clinical outcomes for these patients. Hence, we believe that there is a need for future prospective trials addressing this issue.
Disclosures S. Mannava: None. A. Garg: None.
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