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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Published on: January 18, 2018

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Critical care in acute ischemic stroke.

M McDermott1, T Jacobs2, L Morgenstern1

  • 1Stroke Program, University of Michigan, Ann Arbor, MI, USA.

Handbook of Clinical Neurology
|February 12, 2017
PubMed
Summary
This summary is machine-generated.

Neurocritical care improves outcomes for acute ischemic stroke patients needing intensive management. This includes specialized care for airway issues, large infarctions, seizures, and blood pressure control after treatments.

Keywords:
ICUacute ischemic strokebasilar thrombosisblood pressuredecompressive hemicraniectomyhyperglycemiamechanical thrombectomytemperaturethrombolysis

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Area of Science:

  • Neurology
  • Critical Care Medicine

Background:

  • Most ischemic strokes are managed on general wards or stroke units.
  • A significant number of patients require specialized neurocritical care for optimal outcomes.
  • Existing research indicates improved outcomes with available neurocritical care services.

Purpose of the Study:

  • To outline key aspects of acute ischemic stroke care relevant to neurointensivists.
  • To detail management strategies for complex cases requiring intensive care unit (ICU)-level care.
  • To discuss specific interventions like decompressive hemicraniectomy and basilar artery thrombosis management.

Main Methods:

  • Review of neuropathology, neurodiagnostics, and imaging in acute ischemic stroke.
  • Discussion of critical care management principles: blood pressure, glycemic, and temperature control.
  • Focus on post-thrombolysis and post-mechanical thrombectomy care, including antithrombotic selection.

Main Results:

  • Identified key indicators for ICU admission: respiratory compromise, large hemispheric infarction with swelling, hemorrhagic transformation, and seizures.
  • Highlighted the importance of meticulous blood pressure management, especially after thrombolytics.
  • Addressed complex decision-making for interventions like decompressive hemicraniectomy and basilar artery thrombosis.

Conclusions:

  • Neurocritical care is essential for acute ischemic stroke patients with specific high-risk features.
  • Comprehensive management encompassing neuropathology, diagnostics, and tailored interventions improves patient outcomes.
  • Specialized neurointensivist expertise is crucial for managing complex stroke cases and advanced therapies.