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01-08-2017 | Stroke (JF Meschia, Section Editor)

Update on Neurocritical Care of Stroke

Authors: Jason Siegel, Michael A. Pizzi, J. Brent Peel, David Alejos, Nnenne Mbabuike, Benjamin L. Brown, David Hodge, W. David Freeman

Published in: Current Cardiology Reports | Issue 8/2017

Abstract

Purpose of Review

This review will highlight the recent advancements in acute ischemic stroke diagnosis and treatment, with special attention to new features and recommendations of stroke care in the neurocritical care unit.

Recent Findings

New studies suggest that pre-hospital treatment of stroke with mobile stroke units and telestroke technology may lead to earlier stroke therapy with intravenous tissue plasminogen activator (tPA), and recent studies show tPA can be given in previously contraindicated situations. More rapid automated CT perfusion and angiography may demonstrate a vascular penumbra for neuroendovascular intervention. Further, the greatest advance in acute stroke treatment since 2014 is the demonstration that neuroendovascular catheter-based thrombectomy with stent retrievers recanalizing intracranial large vessel occlusion (LVO) improves both recanalization and long-term outcomes in several trials. Hemorrhagic transformation and severe large infarct cerebral edema remain serious post-stroke challenges, with new guidelines describing who and when patients should get medical or surgical intervention.

Summary

The adage “time is brain” directs the most evidence-based approach for rapid stroke diagnosis for tPA eligible and LVO recanalization using an orchestrated team approach. The neurocritical care unit is the appropriate location to optimize stroke outcomes for the most severely affected stroke patients.

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Title: Update on Neurocritical Care of Stroke
Authors: Jason Siegel
Michael A. Pizzi
J. Brent Peel
David Alejos
Nnenne Mbabuike
Benjamin L. Brown
David Hodge
W. David Freeman
Publication date: 01-08-2017
Publisher: Springer US
Published in: Current Cardiology Reports / Issue 8/2017
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI: https://doi.org/10.1007/s11886-017-0881-7

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