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J Intensive Care Med. 2017 Jul;32(6):373-386. doi: 10.1177/0885066616656361. Epub 2016 Jul 19.

Neurocritical Care of Emergent Large-Vessel Occlusion: The Era of a New Standard of Care.

Author information

1
1 Department of Neurology, Columbia University Medical Center, Neurological Institute of New York, New York, NY, USA.
2
2 Department of Neurosurgery and Neuroscience; Rutgers University School of Medicine, Newark, NJ, USA.
3
3 Departments of Neurology and Neurosurgery, Ichan School of Medicine at Mount Sinai, New York, NY, USA.
4
4 Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
5
5 Departments of Neurology and Neurosurgery, Columbia University Medical Center, New York, NY, USA.
6
6 Departments of Neurosurgery and Radiology; Columbia University Medical Center, New York, NY, USA.

Abstract

Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. Peri- and postinterventional neurocritical care of the patient who has had an emergent large-vessel occlusion is likely an equally important contributor to the outcome but has been relatively neglected. Critical periprocedural management issues include streamlining care to speed intervention, blood pressure optimization, reversal of anticoagulation, management of agitation, and selection of anesthetic technique (ie, general vs monitored anesthesia care). Postprocedural critical care issues that might modulate neurological outcome include blood pressure and glucose optimization, avoidance of fever or hyperoxia, fluid and nutritional management, and early integration of rehabilitation into the intensive care unit setting. In this review, we sought to lay down an evidence-based strategy for patients with acute ischemic stroke undergoing emergent endovascular reperfusion.

KEYWORDS:

acute ischemic stroke; mechanical thrombectomy; neurocritical care management

PMID:
27435906
DOI:
10.1177/0885066616656361
[Indexed for MEDLINE]

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