Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 9/2019

01-09-2019 | Stroke | Review

Acute ischaemic stroke: challenges for the intensivist

Authors: M. Smith, U. Reddy, C. Robba, D. Sharma, G. Citerio

Published in: Intensive Care Medicine | Issue 9/2019

Login to get access

Abstract

Purpose

To provide an update about the rapidly developing changes in the critical care management of acute ischaemic stroke patients.

Methods

A narrative review was conducted in five general areas of acute ischaemic stroke management: reperfusion strategies, anesthesia for endovascular thrombectomy, intensive care unit management, intracranial complications, and ethical considerations.

Results

The introduction of effective reperfusion strategies, including IV thrombolysis and endovascular thrombectomy, has revolutionized the management of acute ischaemic stroke and transformed outcomes for patients. Acute therapeutic efforts are targeted to restoring blood flow to the ischaemic penumbra before irreversible tissue injury has occurred. To optimize patient outcomes, secondary insults, such as hypotension, hyperthermia, or hyperglycaemia, that can extend the penumbral area must also be prevented or corrected. The ICU management of acute ischaemic stroke patients, therefore, focuses on the optimization of systemic physiological homeostasis, management of intracranial complications, and neurological and haemodynamic monitoring after reperfusion therapies. Meticulous blood pressure management is of central importance in improving outcomes, particularly in patients that have undergone reperfusion therapies.

Conclusions

While consensus guidelines are available to guide clinical decision making after acute ischaemic stroke, there is limited high-quality evidence for many of the recommended interventions. However, a bundle of medical, endovascular, and surgical strategies, when applied in a timely and consistent manner, can improve long-term stroke outcomes.
Appendix
Available only for authorised users
Literature
1.
Gorelick PB (2019) The global burden of stroke: persistent and disabling. Lancet Neurol 18:417–418CrossRefPubMed
2.
Bandera E, Botteri M, Minelli C, Sutton A, Abrams KR, Latronico N (2006) Cerebral blood flow threshold of ischemic penumbra and infarct core in acute ischemic stroke: a systematic review. Stroke 37:1334–1339CrossRefPubMed
3.
Astrup J, Siesjo BK, Symon L (1981) Thresholds in cerebral ischemia—the ischemic penumbra. Stroke 12:723–725CrossRefPubMed
4.
Lo EH (2008) A new penumbra: transitioning from injury into repair after stroke. Nat Med 14:497–500CrossRefPubMed
5.
Stroke Unit Trialists’ Collaboration (2013) Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 9:CD000197
6.
Kirkman MA, Citerio G, Smith M (2014) The intensive care management of acute ischemic stroke: an overview. Intensive Care Med 40:640–653CrossRefPubMed
7.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL (2018) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 49:e46–e110CrossRefPubMed
8.
Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis S, Donnan G, Grotta J, Howard G, Kaste M, Koga M, von KR, Lansberg M, Lindley RI, Murray G, Olivot JM, Parsons M, Tilley B, Toni D, Toyoda K, Wahlgren N, Wardlaw J, Whiteley W, del Zoppo GJ, Baigent C, Sandercock P, Hacke W (2014) Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 384:1929–1935CrossRefPubMedPubMedCentral
9.
Parsons M, Spratt N, Bivard A, Campbell B, Chung K, Miteff F, O’Brien B, Bladin C, McElduff P, Allen C, Bateman G, Donnan G, Davis S, Levi C (2012) A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med 366:1099–1107CrossRefPubMed
10.
Thomalla G, Simonsen CZ, Boutitie F, Andersen G, Berthezene Y, Cheng B, Cheripelli B, Cho TH, Fazekas F, Fiehler J, Ford I, Galinovic I, Gellissen S, Golsari A, Gregori J, Gunther M, Guibernau J, Hausler KG, Hennerici M, Kemmling A, Marstrand J, Modrau B, Neeb L, Perez DLO, Puig J, Ringleb P, Roy P, Scheel E, Schonewille W, Serena J, Sunaert S, Villringer K, Wouters A, Thijs V, Ebinger M, Endres M, Fiebach JB, Lemmens R, Muir KW, Nighoghossian N, Pedraza S, Gerloff C (2018) MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med 379:611–622CrossRefPubMed
11.
Ma H, Campbell BCV, Parsons MW, Churilov L, Levi CR, Hsu C, Kleinig TJ, Wijeratne T, Curtze S, Dewey HM, Miteff F, Tsai CH, Lee JT, Phan TG, Mahant N, Sun MC, Krause M, Sturm J, Grimley R, Chen CH, Hu CJ, Wong AA, Field D, Sun Y, Barber PA, Sabet A, Jannes J, Jeng JS, Clissold B, Markus R, Lin CH, Lien LM, Bladin CF, Christensen S, Yassi N, Sharma G, Bivard A, Desmond PM, Yan B, Mitchell PJ, Thijs V, Carey L, Meretoja A, Davis SM, Donnan GA (2019) Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med 380:1795–1803CrossRefPubMed
12.
Badhiwala JH, Nassiri F, Alhazzani W, Selim MH, Farrokhyar F, Spears J, Kulkarni AV, Singh S, Alqahtani A, Rochwerg B, Alshahrani M, Murty NK, Alhazzani A, Yarascavitch B, Reddy K, Zaidat OO, Almenawer SA (2015) Endovascular thrombectomy for acute ischemic stroke: a meta-analysis. JAMA 314:1832–1843CrossRefPubMed
13.
Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, Davalos A, Majoie CB, van der Lugt A, de Miquel MA, Donnan GA, Roos YB, Bonafe A, Jahan R, Diener HC, van den Berg LA, Levy EI, Berkhemer OA, Pereira VM, Rempel J, Millan M, Davis SM, Roy D, Thornton J, Roman LS, Ribo M, Beumer D, Stouch B, Brown S, Campbell BC, van Oostenbrugge RJ, Saver JL, Hill MD, Jovin TG (2016) Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet 387:1723–1731CrossRefPubMed
14.
15.
Kaesmacher J, Mordasini P, Arnold M, Lopez-Cancio E, Cerda N, Boeckh-Behrens T, Kleine JF, Goyal M, Hill MD, Pereira VM, Saver JL, Gralla J, Fischer U (2019) Direct mechanical thrombectomy in tPA-ineligible and -eligible patients versus the bridging approach: a meta-analysis. J Neurointerv Surg 11:20–27CrossRefPubMed
16.
Tsivgoulis G, Katsanos AH, Schellinger PD, Kohrmann M, Varelas P, Magoufis G, Paciaroni M, Caso V, Alexandrov AW, Gurol E, Alexandrov AV (2018) Successful reperfusion with intravenous thrombolysis preceding mechanical thrombectomy in large-vessel occlusions. Stroke 49:232–235CrossRefPubMed
17.
Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, Yavagal DR, Ribo M, Cognard C, Hanel RA, Sila CA, Hassan AE, Millan M, Levy EI, Mitchell P, Chen M, English JD, Shah QA, Silver FL, Pereira VM, Mehta BP, Baxter BW, Abraham MG, Cardona P, Veznedaroglu E, Hellinger FR, Feng L, Kirmani JF, Lopes DK, Jankowitz BT, Frankel MR, Costalat V, Vora NA, Yoo AJ, Malik AM, Furlan AJ, Rubiera M, Aghaebrahim A, Olivot JM, Tekle WG, Shields R, Graves T, Lewis RJ, Smith WS, Liebeskind DS, Saver JL, Jovin TG (2018) Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med 378:11–21CrossRefPubMed
18.
Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, McTaggart RA, Torbey MT, Kim-Tenser M, Leslie-Mazwi T, Sarraj A, Kasner SE, Ansari SA, Yeatts SD, Hamilton S, Mlynash M, Heit JJ, Zaharchuk G, Kim S, Carrozzella J, Palesch YY, Demchuk AM, Bammer R, Lavori PW, Broderick JP, Lansberg MG (2018) Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med 378:708–718CrossRefPubMedPubMedCentral
19.
Mulder MJHL, Jansen IGH, Goldhoorn RB, Venema E, Chalos V, Compagne KCJ, Roozenbeek B, Lingsma HF, Schonewille WJ, van den Wijngaard IR, Boiten J, Albert VJ, Roos YBWE, van Oostenbrugge RJ, van Zwam WH, Majoie CBLM, van der Lugt A, Dippel DWJ (2018) Time to endovascular treatment and outcome in acute ischemic stroke: MR CLEAN registry results. Circulation 138:232–240CrossRefPubMed
20.
Ismail M, Armoiry X, Tau N, Zhu F, Sadeh-Gonik U, Piotin M, Blanc R, Mazighi M, Bracard S, Anxionnat R, Schmitt E, Mione G, Humbertjean L, Lacour JC, Richard S, Barbier C, Lapergue B, Gory B (2019) Mothership versus drip and ship for thrombectomy in patients who had an acute stroke: a systematic review and meta-analysis. J Neurointerv Surg 11:14–19CrossRefPubMed
21.
Hindman BJ, Dexter F (2019) Anesthetic management of emergency endovascular thrombectomy for acute ischemic stroke, part 2: integrating and applying observational reports and randomized clinical trials. Anesth Analg 128:706–717CrossRefPubMed
22.
Talke PO, Sharma D, Heyer EJ, Bergese SD, Blackham KA, Stevens RD (2014) Society for neuroscience in anesthesiology and critical care expert consensus statement: anesthetic management of endovascular treatment for acute ischemic stroke*: endorsed by the Society of NeuroInterventional Surgery and the Neurocritical Care Society. J Neurosurg Anesthesiol 26:95–108CrossRefPubMed
23.
Hindman BJ (2019) Anesthetic management of emergency endovascular thrombectomy for acute ischemic stroke, part 1: patient characteristics, determinants of effectiveness, and effect of blood pressure on outcome. Anesth Analg 128:695–705CrossRefPubMed
24.
Whalin MK, Halenda KM, Haussen DC, Rebello LC, Frankel MR, Gershon RY, Nogueira RG (2017) Even small decreases in blood pressure during conscious sedation affect clinical outcome after stroke thrombectomy: an analysis of hemodynamic thresholds. AJNR Am J Neuroradiol 38:294–298CrossRefPubMedPubMedCentral
25.
Alcaraz G, Chui J, Schaafsma J, Manninen P, Porta-Sanchez A, Pereira VM, Venkatraghavan L (2019) Hemodynamic management of patients during endovascular treatment of acute ischemic stroke under conscious sedation: a retrospective cohort study. J Neurosurg Anesthesiol 31:299–305CrossRefPubMed
26.
Treurniet KM, Berkhemer OA, Immink RV, Lingsma HF, Ward-van der Stam VMC, Hollmann MW, Vuyk J, van Zwam WH, van der Lugt A, van Oostenbrugge RJ, Dippel DWJ, Coutinho JM, Roos YBWE, Marquering HA, Majoie CBLM (2018) A decrease in blood pressure is associated with unfavorable outcome in patients undergoing thrombectomy under general anesthesia. J Neurointerv Surg 10:107–111CrossRefPubMed
27.
Pikija S, Trkulja V, Ramesmayer C, Mutzenbach JS, Killer-Oberpfalzer M, Hecker C, Bubel N, Fussel MU, Sellner J (2018) Higher blood pressure during endovascular thrombectomy in anterior circulation stroke is associated with better outcomes. J Stroke 20:373–384CrossRefPubMedPubMedCentral
28.
Athiraman U, Sultan-Qurraie A, Nair B, Tirschwell DL, Ghodke B, Havenon AD, Hallam DK, Kim LJ, Becker KJ, Sharma D (2018) Endovascular treatment of acute ischemic stroke under general anesthesia: predictors of good outcome. J Neurosurg Anesthesiol 30:223–230PubMed
29.
Jadhav AP, Molyneaux BJ, Hill MD, Jovin TG (2018) Care of the post-thrombectomy patient. Stroke 49:2801–2807CrossRefPubMed
30.
31.
32.
Pelosi P, Ferguson ND, Frutos-Vivar F, Anzueto A, Putensen C, Raymondos K, Apezteguia C, Desmery P, Hurtado J, Abroug F, Elizalde J, Tomicic V, Cakar N, Gonzalez M, Arabi Y, Moreno R, Esteban A (2011) Management and outcome of mechanically ventilated neurologic patients. Crit Care Med 39:1482–1492CrossRefPubMed
33.
Kiphuth IC, Schellinger PD, Kohrmann M, Bardutzky J, Lucking H, Kloska S, Schwab S, Huttner HB (2010) Predictors for good functional outcome after neurocritical care. Crit Care 14:R136CrossRefPubMedPubMedCentral
34.
Santoli F, De JB, Hayon J, Tran B, Piperaud M, Merrer J, Outin H (2001) Mechanical ventilation in patients with acute ischemic stroke: survival and outcome at one year. Intensive Care Med 27:1141–1146CrossRefPubMed
35.
Berrouschot J, Rossler A, Koster J, Schneider D (2000) Mechanical ventilation in patients with hemispheric ischemic stroke. Crit Care Med 28:2956–2961CrossRefPubMed
36.
Rowat AM, Dennis MS, Wardlaw JM (2006) Hypoxaemia in acute stroke is frequent and worsens outcome. Cerebrovasc Dis 21:166–172CrossRefPubMed
37.
Roffe C, Nevatte T, Sim J, Bishop J, Ives N, Ferdinand P, Gray R (2017) Effect of routine low-dose oxygen supplementation on death and disability in adults with acute stroke: the stroke oxygen study randomized clinical trial. JAMA 318:1125–1135CrossRefPubMedPubMedCentral
38.
Schonenberger S, Niesen WD, Fuhrer H, Bauza C, Klose C, Kieser M, Suarez JI, Seder DB, Bosel J (2016) Early tracheostomy in ventilated stroke patients: study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2). Int J Stroke 11:368–379CrossRefPubMed
39.
Dziewas R, Stellato R, van DTI, Walther E, Werner CJ, Braun T, Citerio G, Jandl M, Friedrichs M, Notzel K, Vosko MR, Mistry S, Hamdy S, McGowan S, Warnecke T, Zwittag P, Bath PM (2018) Pharyngeal electrical stimulation for early decannulation in tracheotomised patients with neurogenic dysphagia after stroke (PHAST-TRAC): a prospective, single-blinded, randomised trial. Lancet Neurol 17:849–859CrossRefPubMed
40.
Ko SB, Yoon BW (2017) Blood pressure management for acute ischemic and hemorrhagic stroke: the evidence. Semin Respir Crit Care Med 38:718–725CrossRefPubMed
41.
Mistry EA, Mistry AM, Nakawah MO, Khattar NK, Fortuny EM, Cruz AS, Froehler MT, Chitale RV, James RF, Fusco MR, Volpi JJ (2017) Systolic blood pressure within 24 hours after thrombectomy for acute ischemic stroke correlates with outcome. J Am Heart Assoc 6:e006167CrossRefPubMedPubMedCentral
42.
Goyal N, Tsivgoulis G, Pandhi A, Chang JJ, Dillard K, Ishfaq MF, Nearing K, Choudhri AF, Hoit D, Alexandrov AW, Arthur AS, Elijovich L, Alexandrov AV (2017) Blood pressure levels post mechanical thrombectomy and outcomes in large vessel occlusion strokes. Neurology 89:540–547CrossRefPubMed
43.
Goyal N, Tsivgoulis G, Pandhi A, Dillard K, Alsbrook D, Chang JJ, Krishnaiah B, Nickele C, Hoit D, Alsherbini K, Alexandrov AV, Arthur AS, Elijovich L (2018) Blood pressure levels post mechanical thrombectomy and outcomes in non-recanalized large vessel occlusion patients. J Neurointerv Surg 10:925–931CrossRefPubMed
44.
Manning LS, Mistri AK, Potter J, Rothwell PM, Robinson TG (2015) Short-term blood pressure variability in acute stroke: post hoc analysis of the controlling hypertension and hypotension immediately post stroke and continue or stop post-stroke antihypertensives collaborative study trials. Stroke 46:1518–1524CrossRefPubMed
45.
Mundiyanapurath S, Stehr A, Wolf M, Kieser M, Mohlenbruch M, Bendszus M, Hacke W, Bosel J (2016) Pulmonary and circulatory parameter guided anesthesia in patients with ischemic stroke undergoing endovascular recanalization. J Neurointerv Surg 8:335–341CrossRefPubMed
46.
Mistry EA, Mayer SA, Khatri P (2018) Blood pressure management after mechanical thrombectomy for acute ischemic atroke: a survey of the StrokeNet Sites. J Stroke Cerebrovasc Dis 27:2474–2478CrossRefPubMed
47.
Wartenberg KE, Mayer SA (2017) Determining the optimal target blood pressure after thrombectomy: high or low? Neurology 89:528–529CrossRefPubMed
48.
Greer DM, Funk SE, Reaven NL, Ouzounelli M, Uman GC (2008) Impact of fever on outcome in patients with stroke and neurologic injury: a comprehensive meta-analysis. Stroke 39:3029–3035CrossRefPubMed
49.
Andrews PJD, Verma V, Healy M, Lavinio A, Curtis C, Reddy U, Andrzejowski J, Foulkes A, Canestrini S (2018) Targeted temperature management in patients with intracerebral haemorrhage, subarachnoid haemorrhage, or acute ischaemic stroke: consensus recommendations. Br J Anaesth 121:768–775CrossRefPubMed
50.
den Hertog HM, van der Worp HB, van Gemert HM, Algra A, Kappelle LJ, van GJ, Koudstaal PJ, Dippel DW (2009) The paracetamol (acetaminophen) in stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol 8:434–440CrossRef
51.
Dumitrascu OM, Lamb J, Lyden PD (2016) Still cooling after all these years: meta-analysis of pre-clinical trials of therapeutic hypothermia for acute ischemic stroke. J Cereb Blood Flow Metab 36:1157–1164CrossRefPubMedPubMedCentral
52.
Horn CM, Sun CH, Nogueira RG, Patel VN, Krishnan A, Glenn BA, Belagaje SR, Thomas TT, Anderson AM, Frankel MR, Schindler KM, Gupta R (2014) Endovascular reperfusion and cooling in cerebral acute ischemia (ReCCLAIM I). J Neurointerv Surg 6:91–95CrossRefPubMed
53.
Basto FM, Lyden P (2018) Hypothermia in acute ischemic stroke therapy. Handb Clin Neurol 157:823–837CrossRefPubMed
54.
Wang Y, Pan Y, Zhao X, Li H, Wang D, Johnston SC, Liu L, Meng X, Wang A, Wang C, Wang Y (2015) Clopidogrel with aspirin in acute minor stroke or transient ischemic attack (CHANCE) trial: one-year outcomes. Circulation 132:40–46CrossRefPubMed
55.
Johnston SC, Easton JD, Farrant M, Barsan W, Conwit RA, Elm JJ, Kim AS, Lindblad AS, Palesch YY (2018) Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med 379:215–225CrossRefPubMedPubMedCentral
56.
57.
58.
Bembenek J, Karlinski M, Kobayashi A, Czlonkowska A (2011) Early stroke-related deep venous thrombosis: risk factors and influence on outcome. J Thromb Thrombolysis 32:96–102CrossRefPubMedPubMedCentral
59.
Dennis M, Sandercock P, Reid J, Graham C, Forbes J, Murray G (2013) Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet 382:516–524CrossRefPubMed
60.
61.
Arabi YM, Al-Hameed F, Burns KEA, Mehta S, Alsolamy SJ, Alshahrani MS, Mandourah Y, Almekhlafi GA, Almaani M, Al BA, Finfer S, Arshad Z, Khalid I, Mehta Y, Gaur A, Hawa H, Buscher H, Lababidi H, Al AA, Abdukahil SAI, Jose J, Afesh LY, Al-Dawood A (2019) Adjunctive intermittent pneumatic compression for venous thromboprophylaxis. N Engl J Med 380:1305–1315CrossRefPubMed
62.
63.
Kagansky N, Levy S, Knobler H (2001) The role of hyperglycemia in acute stroke. Arch Neurol 58:1209–1212CrossRefPubMed
64.
Alvarez-Sabin J, Molina CA, Montaner J, Arenillas JF, Huertas R, Ribo M, Codina A, Quintana M (2003) Effects of admission hyperglycemia on stroke outcome in reperfused tissue plasminogen activator-treated patients. Stroke 34:1235–1241CrossRefPubMed
65.
66.
Kim JT, Liebeskind DS, Jahan R, Menon BK, Goyal M, Nogueira RG, Pereira VM, Gralla J, Saver JL (2018) Impact of hyperglycemia according to the collateral status on outcomes in mechanical thrombectomy. Stroke 49:2706–2714CrossRefPubMed
67.
68.
Dennis M, Lewis S, Cranswick G, Forbes J (2006) FOOD: a multicentre randomised trial evaluating feeding policies in patients admitted to hospital with a recent stroke. Health Technol Assess 10:1CrossRef
69.
Oddo M, Poole D, Helbok R, Meyfroidt G, Stocchetti N, Bouzat P, Cecconi M, Geeraerts T, Martin-Loeches I, Quintard H, Taccone FS, Geocadin RG, Hemphill C, Ichai C, Menon D, Payen JF, Perner A, Smith M, Suarez J, Videtta W, Zanier ER, Citerio G (2018) Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations. Intensive Care Med 44:449–463CrossRefPubMed
70.
AVERT Trial Collaboration Group (2015) Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet 386:46–55CrossRef
71.
Neuberger U, Kickingereder P, Schonenberger S, Schieber S, Ringleb PA, Bendszus M, Pfaff J, Mohlenbruch MA (2019) Risk factors of intracranial hemorrhage after mechanical thrombectomy of anterior circulation ischemic stroke. Neuroradiology 61:461–469CrossRefPubMed
72.
McDermott M, Jacobs T, Morgenstern L (2017) Critical care in acute ischemic stroke. Handb Clin Neurol 140:153–176CrossRefPubMed
73.
Frontera JA, Lewin JJ III, Rabinstein AA, Aisiku IP, Alexandrov AW, Cook AM, del Zoppo GJ, Kumar MA, Peerschke EI, Stiefel MF, Teitelbaum JS, Wartenberg KE, Zerfoss CL (2016) Guideline for reversal of antithrombotics in intracranial hemorrhage: a statement for healthcare professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care 24:6–46CrossRefPubMed
74.
Kimberly WT, Dutra BG, Boers AMM, Alves HCBR, Berkhemer OA, van den Berg L, Sheth KN, Roos YBWE, van der Lugt A, Beenen LFM, Dippel DWJ, van Zwam WH, van Oostenbrugge RJ, Lingsma HF, Marquering H, Majoie CBLM (2018) Association of reperfusion with brain edema in patients with acute ischemic stroke: a secondary analysis of the MR CLEAN Trial. JAMA Neurol 75:453–461CrossRefPubMedPubMedCentral
75.
Huttner HB, Schwab S (2009) Malignant middle cerebral artery infarction: clinical characteristics, treatment strategies, and future perspectives. Lancet Neurol 8:949–958CrossRefPubMed
76.
Smith M (2017) Refractory intracranial hypertension: the role of decompressive craniectomy. Anesth Analg 125:1999–2008CrossRefPubMed
77.
Vahedi K, Hofmeijer J, Juettler E, Vicaut E, George B, Algra A, Amelink GJ, Schmiedeck P, Schwab S, Rothwell PM, Bousser MG, van der Worp HB, Hacke W (2007) Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials. Lancet Neurol 6:215–222CrossRefPubMed
78.
79.
Juttler E, Unterberg A, Woitzik J, Bosel J, Amiri H, Sakowitz OW, Gondan M, Schiller P, Limprecht R, Luntz S, Schneider H, Pinzer T, Hobohm C, Meixensberger J, Hacke W (2014) Hemicraniectomy in older patients with extensive middle-cerebral-artery stroke. N Engl J Med 370:1091–1100CrossRefPubMed
80.
Fried TR, Zenoni M, Iannone L, O’Leary J, Fenton BT (2017) Engagement in advance care planning and surrogates’ knowledge of patients’ treatment goals. J Am Geriatr Soc 65:1712–1718CrossRefPubMedPubMedCentral
81.
Honeybul S, Gillett GR, Ho KM, Janzen C, Kruger K (2016) Is life worth living? Decompressive craniectomy and the disability paradox. J Neurosurg 125:775–778CrossRefPubMed
82.
Muehlschlegel S, Shutter L, Col N, Goldberg R (2015) Decision aids and shared decision-making in neurocritical care: an unmet need in our NeuroICUs. Neurocrit Care 23:127–130CrossRefPubMedPubMedCentral
Metadata
Title
Acute ischaemic stroke: challenges for the intensivist
Authors
M. Smith
U. Reddy
C. Robba
D. Sharma
G. Citerio
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 9/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05705-y

Other articles of this Issue 9/2019

Intensive Care Medicine 9/2019 Go to the issue

Original

Speckle tracking quantification of lung sliding for the diagnosis of pneumothorax: a multicentric observational study

Imaging in Intensive Care Medicine

Green plasma and a blocked CRRT circuit due to drug-induced hyperlipidemia

Letter

Effects of increasing PEEP on lung stress and strain in children with and without ARDS

Editorial

Focus on blood pressure targets and vasopressors in critically ill patients

Original

“You helped me keep my head above water”—experience of bereavement research after loss of a loved one in the ICU: insights from the ARREVE study

Less is More

When less is more in the active management of elevated body temperature of ICU patients