Over the past few decades, the management of acute ischemic stroke has witnessed remarkable progress. The advent of intravenous thrombolysis and, more recently, the success of endovascular mechanical thrombectomy trials for large vessel occlusion have transformed the landscape of neurocritical care. These therapies aim to restore blood flow promptly, salvaging ischemic brain tissue. However, this rapid reperfusion introduces a unique set of potential complications, including reperfusion injury, inflammation, and oxidative stress that must be understood, anticipated, and managed in the neurointensive care unit (NICU) to maximize patient outcomes.

While restoring blood flow to ischemic brain tissue is essential, it can paradoxically lead to reperfusion injury. This phenomenon involves oxidative stress, neuroinflammation, endothelial injury, and cerebral autoregulation dysfunction. Elucidating pathophysiology mechanisms and balancing the benefits of reperfusion against the risks of injury remains a delicate task for neurointensivists. Reperfusion therapies carry the risk of symptomatic intracranial hemorrhage (sICH), a potentially devastating complication. Vigilant monitoring and prompt recognition are paramount. Therefore, bedside multimodal monitoring (MMM) providing insights about optimal cerebral oxygenation, blood pressure control, and tissue perfusion to individualized care and early recognition makes it intriguing for NeuroICU. Apart from these, assessment of collateral circulation as well as post-treatment hyper-perfusion helps predict response to therapy, identify high-risk patients, and guide decision-making. Patients who need reperfusion therapy vary with risk factors and constitute a considerably diverse population. In this scenario, predicting patient outcomes is essential for tailored management. Prognostic models based on clinical and radiological parameters help guide decisions. These models integrate factors such as age, stroke severity, imaging findings, biomarkers, and comorbidities to estimate prognosis. By identifying high-risk patients early, we can tailor interventions and allocate resources effectively. Moreover, despite encouraging progression has been made, bench-to-bedside translation is warranted for appealing novel therapies, biomarkers, and neuroprotective agents for peri-reperfusion therapy management. Collaborations between basic scientists, clinicians, and critical care experts drive innovation in neurocritical care.

This Research Topic aims to provide the most recent update of the basic science theory and advanced management protocol for critical-ill patients after reperfusion therapy. We hope to foster best practices in caring for peri-reperfusion therapy management in NICU. We welcome submissions of Original Research articles, Reviews, Mini-reviews, Commentaries, etc.

Potential topics include but are not limited to the following:

1. Current understanding of direct and indirect mechanisms of secondary brain injury following reperfusion therapy.
2. Management modalities of patient after reperfusion therapy in NICU.
3. Practical strategies for titration of optimal blood pressure, cerebral oxygenation, and perfusion.
4. Surveillance and treatment of hyper-perfusion after reperfusion therapy.
5. Advanced medical therapy during the acute phase of post-reperfusion therapy.
6. Advancements in multimodal monitoring and evolving paradigm on the management of peri-reperfusion therapy.
7. Cerebral autoregulation and neurovascular coupling after reperfusion therapy.
8. Prediction models and prognostic models of symptomatic intracerebral hemorrhage after reperfusion therapy.

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Frontiers in Neurology

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