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Managing stroke after TPA/Embolectomy

      Recently, strong evidence has been found in improving outcomes in stroke victims with intra-arterial thrombectomy and embolectomy in conjunction with intravenous thrombolysis for proximal, anterior circulation occlusions. While achieving reperfusion is the first step, there are subsequent, important management issues after successful thrombolysis and embolectomy. Post interventional management includes close neurological monitoring for prompt recognition of potential malignant edema in order to consider hemicraniectomy and adequate hemodynamic management in order to provide sufficient delivery of oxygen and last but not least, blood pressure management in order to avoid hemorrhagic complications that may occur with reperfusion. Consideration for potential ongoing ischemia especially in the distal microcirculations and potential reperfusion related hemorrhages is critical after thrombolysis and embolectomy. Understanding risks and adverse events that are associated with hemicranicectomy is also important.
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