Focused ReviewPeriprocedure Management of Blood Pressure After Acute Ischemic StrokeSharma, Deepak MBBS, MD, DM Author Information Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA D.S. is a member of the Editorial Board of the Journal of Neurosurgical Anesthesiology. The author has no other conflicts of interest to declare. Address correspondence to: Deepak Sharma, MBBS, MD, DM, University of Washington, Box # 359724, Seattle, WA, E-mail: [email protected]. Journal of Neurosurgical Anesthesiology: November 1, 2022 - Volume - Issue - 10.1097/ANA.0000000000000891 doi: 10.1097/ANA.0000000000000891 Buy PAP Metrics Abstract The management of acute ischemic stroke primarily revolves around the timely restoration of blood flow (recanalization/reperfusion) in the occluded vessel and maintenance of cerebral perfusion through collaterals before reperfusion. Mechanical thrombectomy is the most effective treatment for acute ischemic stroke due to large vessel occlusions in appropriately selected patients. Judicious management of blood pressure before, during, and after mechanical thrombectomy is critical to ensure good outcomes by preventing progression of cerebral ischemia as well hemorrhagic conversion, in addition to optimizing systemic perfusion. While direct evidence to support specific hemodynamic targets around mechanical thrombectomy is limited, there is increasing interest in this area. Newer approaches to blood pressure management utilizing individualized cerebral autoregulation-based targets are being explored. Early efforts at utilizing machine learning to predict blood pressure treatment thresholds and therapies also seem promising; this focused review aims to provide an update on recent evidence around periprocedural blood pressure management after acute ischemic stroke, highlighting its implications for clinical practice while identifying gaps in current literature. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.