ABSTRACT
Arterial blood pressure is often elevated during acute ischemic stroke and is postulated to be protective as hypertension may maintain perfusion in the penumbra surrounding the stroke. Blood pressure management during mechanical thrombectomy and type of anesthesia is also controversial. Because general anesthesia (GA) might have a greater propensity to cause a lower blood pressure and retrospective studies have shown that patients receiving GA have worse neurological outcomes compared to patients who have received conscious sedation, many neuro-interventional radiologists prefer monitored anesthesia care for these procedures. Similar to patients with acute ischemic stroke, blood pressure is often elevated in patients with spontaneous intracerebral hemorrhage and may cause expansion of the hematoma with an increase in intracranial pressure. A randomized controlled prehospital trial comparing transdermal nitroglycerin (NTG) to placebo administered within 4 hours of stroke onset found that NTG had statistically significant but clinically modest effects on lowering blood pressure.
