Assessment and Management of Ischemic Stroke with Left M1 Occlusion Status Post Thrombectomy

Immediate Post-Thrombectomy Management

The American Heart Association recommends maintaining blood pressure ≤180/105 mmHg during and for 24 hours after the procedure to optimize functional outcomes 1, 2
For patients with successful reperfusion, maintaining blood pressure <180/105 mmHg is recommended to improve outcomes 1
In patients with basilar artery occlusions who have undergone thrombectomy, maintaining systolic BP <140 mmHg in the first 24 hours after successful reperfusion may be beneficial 2
Monitoring for signs of neurological deterioration is crucial to identify complications such as hemorrhagic transformation or re-occlusion 1

The American Heart Association recommends administration of aspirin within 24-48 hours after stroke onset to improve outcomes 2
For patients who received IV alteplase prior to thrombectomy, aspirin administration should generally be delayed until 24 hours after thrombolysis to minimize risks 2

Early rehabilitation assessments and interventions should be initiated to optimize functional outcomes 1
The technical goal of thrombectomy should be reperfusion to modified Thrombolysis in Cerebral Infarction (mTICI) grade 2b/3 to maximize probability of good functional outcome 1, 3

Transfer to a comprehensive stroke center should be considered if the patient is not already at one to ensure access to specialized care 4, 5
Regional systems of stroke care should include healthcare facilities that provide initial emergency care and centers capable of performing endovascular stroke treatment 4

Inadequate blood pressure control post-thrombectomy can lead to poor outcomes, and should be managed carefully 1, 2
Delayed initiation of rehabilitation services can negatively impact functional outcomes, and should be avoided 1