Initial hospital management of patients with emergent large vessel occlusion (ELVO): report of the standards and guidelines committee of the Society of NeuroInterventional Surgery
| Autor: | Seon Kyu Lee, Sameer A. Ansari, Philip M. Meyers, Ryan A McTaggart, Felipe C. Albuquerque, Barb Albani, Peter A. Rasmussen, Adam J. Arthur, Michael Kelly, Michael J. Alexander, Robert M. Starke, Ketan R. Bulsara, Chirag D. Gandhi, T. M. Leslie-Mawzi, Justin F. Fraser, G. Lee Pride, Athos Patsalides, Mahesh V Jayaraman, Michael Chen, Peter Sunenshine, Mayank Goyal, Don Heck, Blaise Baxter, Todd Abruzzo, Donald Frei, Josser E Delgado Almandoz, M. Shazam Hussain, Charles J. Prestigiacomo, Steven W. Hetts, Richard P. Klucznik |
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| Rok vydání: | 2015 |
| Předmět: |
Research Report
medicine.medical_specialty medicine.medical_treatment Embolectomy Perfusion scanning 030204 cardiovascular system & hematology Revascularization Neurosurgical Procedures 03 medical and health sciences 0302 clinical medicine Fibrinolytic Agents Fibrinolysis medicine Humans Stroke Societies Medical medicine.diagnostic_test business.industry Patient Selection Endovascular Procedures Disease Management General Medicine medicine.disease Triage United States Surgery Hospitalization Cerebrovascular Disorders Tissue Plasminogen Activator Angiography Practice Guidelines as Topic Reperfusion Neurology (clinical) business 030217 neurology & neurosurgery Medical literature |
| Zdroj: | Journal of neurointerventional surgery. 9(3) |
| ISSN: | 1759-8486 |
| Popis: | ObjectiveTo summarize the current literature regarding the initial hospital management of patients with acute ischemic stroke (AIS) secondary to emergent large vessel occlusion (ELVO), and to offer recommendations designed to decrease the time to endovascular treatment (EVT) for appropriately selected patients with stroke.MethodsUsing guidelines for evidenced-based medicine proposed by the Stroke Council of the American Heart Association, a critical review of all available medical literature supporting best initial medical management of patients with AIS secondary to ELVO was performed. The purpose was to identify processes of care that most expeditiously determine the eligibility of a patient with an acute stroke for interventions including intravenous fibrinolysis with recombinant tissue plasminogen activator (IV tPA) and EVT using mechanical embolectomy.ResultsThis review identifies four elements that are required to achieve timely revascularization in ELVO. (1) In addition to non-contrast CT (NCCT) brain scan, CT angiography should be performed in all patients who meet an institutional threshold for clinical stroke severity. The use of any advanced imaging beyond NCCT should not delay the administration of IV tPA in eligible patients. (2) Activation of the neurointerventional team should occur as soon as possible, based on either confirmation of large vessel occlusion or a prespecified clinical severity threshold. (3) Additional imaging techniques, particularly those intended to physiologically select patients for EVT (CT perfusion and diffusion–perfusion mismatch imaging), may provide additional value, but should not delay EVT. (4) Routine use of general anesthesia during EVT procedures, should be avoided if possible. These workflow recommendations apply to both primary and comprehensive stroke centers and should be tailored to meet the needs of individual institutions.ConclusionsPatients with ELVO are at risk for severe neurologic morbidity and mortality. To achieve the best possible clinical outcomes stroke centers must optimize their triage strategies. Strategies that provide patients with ELVO with the fastest access to reperfusion depend upon detail-oriented process improvement. |
| Databáze: | OpenAIRE |
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