Advances in stroke-associated pneumonia in the era of revascularization therapy

ABSTRACT: In recent decades, the advent of revascularization treatments (RVTs), such as intravenous thrombolysis (IVT) and endovascular therapy, has significantly improved clinical outcomes in patients with acute ischemic stroke (AIS). However, stroke-associated pneumonia (SAP) remains a common complication that has a negative impact on the prognosis. This review addresses the mechanisms underlying the development of SAP in patients with AIS, evaluates risk factors, and discusses therapeutic and preventive measures in the era of RVTs. Despite advances in acute stroke care, the incidence of SAP remains high, particularly in patients who receive endovascular treatment (EVT), possibly because of prolonged mechanical ventilation, the effects of anesthesia, and stays in the intensive care unit. Immunodepression, dysphagia, lung damage, and changes in the gut microbiota are central to the pathogenesis of SAP. Current prevention strategies, including screening for dysphagia, oral hygiene, and immunomodulation, show promise but require further validation. Future research should focus on integrating biomarkers and imaging markers for early prediction of SAP and developing targeted interventions to improve patient outcomes.