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Acute ischemic stroke — USMLE Step 3 MCQ

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HardEmergency MedicineAcute ischemic strokeUSMLE Step 3

A patient undergoes successful thrombectomy with complete reperfusion for acute ischemic stroke. Postprocedure systolic pressure is 164 mm Hg without hemorrhage. Which blood-pressure strategy best reflects the 2026 AHA/ASA update?

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Correct answer: D — Keep systolic pressure below 180 mm Hg without targeting below 140

The best answer is “Keep systolic pressure below 180 mm Hg without targeting below 140”. Trials reviewed in the 2026 guideline found no functional benefit from more intensive blood-pressure reduction after reperfusion and potential harm after thrombectomy. An intensive systolic target below 140 mm Hg is therefore not recommended even after complete reperfusion; standard protocolized postreperfusion control remains appropriate.

Reference: 2026 AHA/ASA Guideline for Early Management of Acute Ischemic Stroke: https://professional.heart.org/en/science-news/2026-guideline-for-the-early-management-of-patients-with-acute-ischemic-stroke/top-things-to-know