Oxygenation and perfusion in large vessel occlusion stroke: rethinking periprocedural management in the endovascular era

Acute ischemic stroke remains a leading cause of death and long-term disability worldwide. In patients with large vessel occlusion (LVO), endovascular thrombectomy (EVT) has revolutionized care by achieving high rates of vessel recanalization. However, successful reperfusion does not guarantee good neurologic outcomes, which emphasizes the importance of periprocedural physiologic optimization. This Commentary argues that oxygenation and perfusion should be considered together when managing patients undergoing EVT, and that the physiologic targets appropriate for patients with LVO may differ from those applicable to non-LVO stroke and broader acute ischemic stroke (AIS) populations.