Blood Pressure Management After Endovascular Thrombectomy.
Blood Pressure Management After Endovascular Thrombectomy.
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DOI：
10.3389/fneur.2021.723461
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发表时间：
2021
影响因子：
3.4
通讯作者：
Petersen NH
中科院分区：
文献类型：
--
作者：
Peng TJ;Ortega-Gutiérrez S;de Havenon A;Petersen NH
血管内血栓切除术（EVT）改变了急性卒中治疗的前景，并已成为前循环大血管闭塞（LVO）卒中患者的标准治疗。尽管成功再灌注，许多LVO卒中患者不能恢复功能独立性。特别是，发现血压（BP）或血流动力学变异性极端的患者临床恢复较差，这表明血压优化是一种潜在的神经保护策略。目前的指南承认缺乏随机试验来评估卒中后即刻的最佳血流动力学管理。再灌注后，可能需要降低血压目标，以防止再灌注损伤和促进半影恢复，但根据患者个体因素（如再灌注程度、梗死面积和总体血流动力学状态）调整适当的血压目标仍不确定。该叙述性综述概述了EVT后BP控制的生理机制，并总结了评价EVT后BP目标的关键观察性研究和临床试验。它还讨论了新的治疗策略和未来的研究领域，可以帮助确定最佳的EVT后血压。
Endovascular thrombectomy (EVT) has changed the landscape of acute stroke therapy and has become the standard of care for selected patients presenting with anterior circulation large-vessel occlusion (LVO) stroke. Despite successful reperfusion, many patients with LVO stroke do not regain functional independence. Particularly, patients presenting with extremes of blood pressure (BP) or hemodynamic variability are found to have a worse clinical recovery, suggesting blood pressure optimization as a potential neuroprotective strategy. Current guidelines acknowledge the lack of randomized trials to evaluate the optimal hemodynamic management during the immediate post-stroke period. Following reperfusion, lower blood pressure targets may be warranted to prevent reperfusion injury and promote penumbral recovery, but adequate BP targets adjusted to individual patient factors such as degree of reperfusion, infarct size, and overall hemodynamic status remain undefined. This narrative review outlines the physiological mechanisms of BP control after EVT and summarizes key observational studies and clinical trials evaluating post-EVT BP targets. It also discusses novel treatment strategies and areas of future research that could aid in the determination of the optimal post-EVT blood pressure.
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影响因子：
8.3
作者：
Mistry EA;Mehta T;Mistry A;Arora N;Starosciak AK;De Los Rios La Rosa F;Siegler JE 3rd;Chitale R;Anadani M;Yaghi S;Khatri P;de Havenon A
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de Havenon A
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