Optimizing cerebral perfusion is key to rescuing salvageable ischemic brain tissue. Despite being an important determinant of cerebral perfusion, there are no effective guidelines for blood pressure (BP) management in acute stroke. The control of cerebral blood flow (CBF) involves a myriad of complex pathways which are largely unaccounted for in stroke management. Due to its unique anatomy and physiology, the cerebrovascular circulation is often treated as a stand-alone system rather than an integral component of the cardiovascular system. In order to optimize the strategies for BP management in acute ischemic stroke, a critical reappraisal of the mechanisms involved in CBF control is needed. In this review, we highlight the important role of collateral circulation and re-examine the pathophysiology of CBF control, namely the determinants of cerebral perfusion pressure gradient and resistance, in the context of stroke. Finally, we summarize the state of our knowledge regarding cardiovascular and cerebrovascular interaction and explore some potential avenues for future research in ischemic stroke.

优化脑灌注是挽救可挽救的缺血性脑组织的关键。尽管是脑灌注的一个重要决定因素，但没有有效的急性卒中血压 (BP) 管理指南。脑血流量 (CBF) 的控制涉及无数复杂的途径，这些途径在中风管理中很大程度上未得到解释。由于其独特的解剖学和生理学，脑血管循环通常被视为一个独立的系统，而不是心血管系统的一个组成部分。为了优化急性缺血性卒中的血压管理策略，需要重新评估参与 CBF 控制的机制。在这篇综述中，我们强调了侧支循环的重要作用，并重新审视了 CBF 控制的病理生理学，即脑灌注压梯度和阻力的决定因素，在中风的背景下。最后，我们总结了我们关于心脑血管相互作用的知识状况，并探索了未来缺血性卒中研究的一些潜在途径。