Care of the Post-Thrombectomy Patient

M ultiple lines of evidence supporting endovascular stroke treatment (EVT) have propelled this treatment modality as the standard of care 1 with increased anticipated and observed utilization.In parallel, it has been recognized that optimal outcomes are reliant on processes across the disease continuum from first medical contact, prehospital triage, primary hospital treatment, interfacility transfer, destination hospital care, preprocedural planning, reperfusion therapy, post-thrombectomy care, and rehabilitation.In this review, we focus specifically on considerations in the care of the postthrombectomy patient.In particular, we address the common and critical complications as they occur over the spectrum of care from preprocedural, intraprocedural, and postprocedural management (Figure ). Key Issues in Patients Undergoing EVTComplications after EVT can be broadly considered as being inherent to issues surrounding the stroke itself (hyperglycemia, temperature dysregulation, arrhythmias, hemodynamic instability, aspiration, respiratory failure, and infection), as well as issues commonly encountered in all critically ill patients, such as stress ulcers, pressure ulcers, and peripheral venous thrombosis.Complications can also be secondarily related to the procedure (hemorrhagic conversion and malignant edema) or direct complications (volume overload, arteriotomy site complications, vessel perforation, vasospasm, device retention, and vessel reocclusion).Adverse events may further be different in reperfused versus nonreperfused patients.For instance, reperfusion injury is not a feature of nonreperfused patients, whereas infarct growth is.Key management decisions include blood pressure (BP) parameters, glucose target, fluid balance, medication use (ie, antithrombotics, anticoagulants, and antiepileptics), as well as necessity and timing of surgical interventions (eg, craniectomy, extraventricular drain placement, tracheostomy, and parenteral gastrostomy).Given the broad spectrum and complex nature of adverse events, the postoperative care should be directed in an intensive care unit with stroke-specialized nursing and physicians.