Under pressure Treatment of acute stroke

The focus of this thesis is on blood pressure management in acute stroke in the setting of short therapeutic time windows for treatments that necessitate urgent decisions, hence the title ‘Under pressure’.
Observational and randomized data were used, and the results of a qualitative survey. We found that high admission blood pressure is associated with poor clinical outcomes in patients with acute ischemic stroke who receive endovascular treatment, irrespective of treatment with intravenous thrombolysis prior to endovascular treatment.
In the MR ASAP trial, we investigated the effects of treatment with transdermal nitroglycerin, which has a mild blood pressure lowering effect without reducing cerebral blood flow, in presumed acute stroke in the prehospital setting. We concluded that transdermal nitroglycerin should be avoided in the first hours after onset of intracerebral hemorrhage. We found no benefit of transdermal nitroglycerin in acute ischemic stroke.
Deferred consent allows emergency interventional studies to be performed in patients with an inability to provide informed consent without causing delays. Most patients that were enrolled with deferred consent judge deferral of consent to after the acute phase acceptable. We report data that can be used as arguments for more frequent implementation of deferred consent in acute stroke research.