How do you approach long-term blood pressure parameters in ischemic stroke patients with severe symptomatic intracranial stenosis?

Every patient is unique and I just try to be as low and slow as possible. 4-6 weeks seems to be where most people do well with others tolerating more (I'm able to get them to under 140 or even 120 during their hospitalization over a few days). In the acute setting, I've found it helpful to make sure people can perform everyday activities at a given BP without triggering symptoms before discharge (e.g., walking unassisted, eating, and Valsalva on the toilet).

If a higher blood pressure range is required to control the patient's TIA symptoms, I would adjust the BP goal accordingly. If something can be done directly to ameliorate the most severe, symptomatic stenosis, then after the procedure I would return to a usual BP range.