Pharmacologic and Medical Management in the Setting of Endovascular Stroke Interventions: A Comprehensive Overview to Management

Abstract Endovascular therapy (EVT) has transformed acute ischemic stroke management, achieving successful vessel recanalization in approximately 70 to 80% of patients. Despite these advances, recommendations regarding medical management in the setting of EVT remain complex and variable across institutions. In keeping, this work presents a comprehensive overview of medical management in the setting of EVT is presented to provide direction and clarity regarding essential components of management, thus promoting positive outcomes and minimizing morbidity/mortality. In the preprocedural setting, intravenous thrombolysis remains standard therapy for eligible patients, while periprocedural anticoagulation and antiplatelet therapies are generally discouraged due to increased risk of hemorrhage and lack of functional benefit, with select exceptions such as emergency stenting for tandem lesions. Postprocedural blood pressure management should be individualized, with consensus favoring systolic blood pressure targets below 160 mm Hg after reperfusion, noting that higher targets (up to 180 mm Hg) may be considered in cases of incomplete reperfusion, and excessively low targets (<120 mm Hg) may be detrimental to maintaining adequate cerebral perfusion. Ongoing research is refining optimal management strategies to improve outcomes in this population further.