There is mounting evidence

linking extremely low admission BP levels with adverse early and late functional outcomes in patients presenting with ACI [10] and [11]. Ponatinib In addition the results of a recent randomized phase III trial showed that acute antihypertensive therapy causing mild BP reductions (3–6 mmHg) during the first 7 days of AIS was not related to better functional outcome or lower rates of cardiovascular events when compared to placebo. In contrast, stroke progression was increased by almost 50% in patients treated with antihypertensive therapy in comparison to the placebo group [12]. The following therapeutic measures may be considered in patients with END caused by SCAEs: 1. Avoiding antihypertensive medications during the first 48 h of ACI (unless systolic

blood pressure/diastolic blood pressure > 220/120 mmHg). Early reocclusion may be the most common mechanism of early clinical fluctuation and worsening after thrombolytic therapy and intra-arterial procedures for acute ischemic stroke, NVP-BEZ235 leading to poor clinic outcome and higher in-hospital mortality [13] and [14]. Thrombolytic therapy has been demonstrated to be effective in acute stroke by dissolving the arterial occlusion and reestablishing tissue perfusion. However, the beneficial effect of tissue plasminogen activator (tPA)-induced recanalization may be eventually hampered by the occurrence of reocclusion [13] and [14]. Early reocclusion occurs in 15–34% of AIS patients treated with iv-tPA achieving any initial recanalization, accounting for up 2/3 of deterioration

following improvement [13] and [14]. Reocclusion can be detected in real-time using transcranial Doppler (TCD) monitoring [13], [14], Resveratrol [15] and [16]. Reocclusion is observed in 17% of patients, who undergo intra-arterial thrombolysis based on catheter angiographic surveillance [17]. Reocclusion can also occur during or after catheter-based interventions [18]. In particular, the prevalence of reocclusion occurring during and within an hour after intra-arterial reperfusion procedures (mechanical thrombectomy, thromboaspiration, intra-arterial thrombolysis) is 19% and 8%, respectively [18]. Reocclusion in stroke patients appears to occur most in those with partial initial recanalization. These patients may be prone to repeated thrombosis and artery-to-artery reembolization particularly in the setting of a large vessel atherosclerosis [14] and [19]. Another potential independent predictor of reocclusion is severe stroke given the fact that increased stroke severity as reflected by higher NIHSS-scores represents larger thrombus burden [20]. Interestingly, Rubiera et al.