Bridging/Adjunct Pharmacotherapy and Peri-procedural Management in Endovascular Thrombectomy (EVT): From Thrombolysis to Antiplatelet Strategies

Endovascular thrombectomy (EVT) has transformed outcomes in acute large-vessel occlusion stroke; however, substantial variability remains in peri-procedural medical management, and this may meaningfully influence reperfusion quality, hemorrhagic complications, infarct evolution, and long-term functional recovery. In particular, the “bridging/adjunct pharmacotherapy” pathway—from intravenous thrombolysis (IVT) decisions and timing, to peri-procedural antiplatelet/antithrombotic strategies for tandem lesions, intracranial atherosclerotic disease (ICAS)-related occlusions, rescue angioplasty/stenting, and early post-EVT secondary prevention—continues to be an area with evolving evidence and heterogeneous practice. In parallel, peri-procedural management elements (blood pressure targets and variability, anesthesia/sedation strategy, hemostasis monitoring, and post-reperfusion intensive care protocols) increasingly appear to interact with pharmacotherapy choices and may jointly determine clinical outcomes.Aligned with the Cardioneurology section’s remit to advance research at the intersection of cardiovascular and neurological disease, this Research Topic will examine how pharmacological and peri-procedural management strategies interact to influence EVT outcomes in acute ischemic stroke. We welcome original research, systematic reviews/meta-analyses, clinical trial reports, consensus statements, and high-quality real-world registry studies. Key themes include but are not limited to:• bridging IVT vs direct EVT and patient selection• antiplatelet/antithrombotic regimens around EVT, including tandem lesions and emergent carotid stenting• ICAS-related large-vessel occlusion (ICAS-LVO), rescue angioplasty/stenting, and peri-procedural antiplatelet strategies • blood pressure management pre-/intra-/post-EVT and interactions with reperfusion and hemorrhage risk• anesthesia/sedation and peri-procedural workflow factors• biomarker and imaging-guided personalization• implementation science and quality improvement in EVT peri-procedural pathways across diverse health systemsThe overarching goal is to integrate evolving evidence into coherent, patient-centered peri-procedural pathways for EVT—linking thrombolysis decisions, antithrombotic strategies, and critical care management. In doing so, the collection seeks to enable more personalized decision-making that improves reperfusion success while reducing hemorrhagic complications and optimizing long-term functional recovery. Topic editors: Ying Xian, Yaxuan Sun, Han Bin Source: https://www.frontiersin.org/research-topics/79656/bridgingadjunct-pharmacotherapy-and-peri-procedural-management-in-endovascular-thrombectomy-evt-from-thrombolysis-to-antiplatelet-strategies