Unit:
Κατεύθυνση Αρτηριακή Υπέρταση και Συνοδά Καρδιαγγειακά-Νεφρικά ΝοσήματαLibrary of the School of Health Sciences
Supervisors info:
Μανιός Ευστάθιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Κόλλιας Αναστάσιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Δούμας Μιχαήλ, Καθηγητής, Ιατρική Σχολή, ΑΠΘ
Original Title:
Διαχείριση της αρτηριακής πίεσης πριν και μετά το πρώτο 24ωρο μετά τη θρομβεκτομή σε αγγειακά ισχαιμικά εγκεφαλικά - Ανασκόπηση
Translated title:
Management of arterial hypertension before and after 24hours of thrombectomy in acute ischemic strokes - Literature Review
Summary:
Hypertension is one of the most significant causes of morbidity and mortality worldwide. It contributes to strokes by causing endothelial cell dysfunction, atherosclerosis, and thromboembolic events. Acute ischemic strokes caused by large vessel occlusion may have a cardioembolic or atherosclerotic etiology, and intravenous thrombolysis and endovascular thrombectomy are the main therapeutic interventions for restoring blood flow to the brain. However, success in reperfusion does not always guarantee a good prognosis due to complications like intracranial hemorrhage and the development of cerebral edema. The literature review aims to clarify the role of blood pressure in acute ischemic strokes undergoing endovascular therapy.
Studies show that increased variability in blood pressure following endovascular thrombectomy is associated with worse outcomes. Maintaining stable blood pressure is critical for improving patient prognosis. Both very low and very high pressures appear to be associated with neurological deterioration, regardless of the success of reperfusion. Researchers are also focusing on the role of anesthetic intervention during thrombectomy. It seems that the type of anesthesia, the medications used, and the experience of the anesthesia team ultimately affect the patient’s blood pressure parameters during the procedure, leading to more targeted guidelines being proposed. The patient's profile and confounding factors such as comorbidities and the type of stroke should be considered for a more personalized approach to blood pressure management.
Continuous monitoring and individualized blood pressure management are essential to reduce related risks. Current guidelines recommend keeping blood pressure below 180/105 mmHg for 24 hours after thrombectomy, but stricter management might be beneficial.
The literature review highlights the need for more high-quality randomized clinical trials to determine the ideal strategies for managing blood pressure in patients undergoing thrombectomy. Adjusting blood pressure management strategies to the individual needs of patients is crucial for optimizing outcomes and reducing risks. The use of monitoring technologies and the incorporation of AI algorithms in the process could improve the accuracy and effectiveness of treatment. Effective blood pressure management and the use of new technologies are key tools for stroke prevention and treatment, leading to better prognosis and improved quality of life for patients.
Main subject category:
Health Sciences
Keywords:
Mechanical thrombectomy, Endovascular thrombectomy, Endovascular therapy, Arterial pressure, Blood pressure management, Acute ischemic stroke, Ischemic cerebrovascular disease
