Update on Neurocritical Care of Stroke

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

Research output: Contribution to journalArticle

6 Citations (Scopus)

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.

Original languageEnglish (US)
Article number67
JournalCurrent Cardiology Reports
Volume19
Issue number8
DOIs
StatePublished - Aug 1 2017

Fingerprint

Stroke
Tissue Plasminogen Activator
Thrombectomy
Brain Edema
Secondary Prevention
Stents
Blood Vessels
Therapeutics
Catheters
Perfusion
Guidelines
Technology
Brain

Keywords

  • Acute ischemic stroke
  • Edema
  • Hemorrhage
  • Neuroimaging
  • Thrombectomy
  • tPA

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Siegel, J., Pizzi, M. A., Brent Peel, J., Alejos, D., Mbabuike, N., Brown, B. L., ... David Freeman, W. (2017). Update on Neurocritical Care of Stroke. Current Cardiology Reports, 19(8), [67]. https://doi.org/10.1007/s11886-017-0881-7

Update on Neurocritical Care of Stroke. / Siegel, Jason; Pizzi, Michael A.; Brent Peel, J.; Alejos, David; Mbabuike, Nnenne; Brown, Benjamin L.; Hodge, David; David Freeman, W.

In: Current Cardiology Reports, Vol. 19, No. 8, 67, 01.08.2017.

Research output: Contribution to journalArticle

Siegel, J, Pizzi, MA, Brent Peel, J, Alejos, D, Mbabuike, N, Brown, BL, Hodge, D & David Freeman, W 2017, 'Update on Neurocritical Care of Stroke', Current Cardiology Reports, vol. 19, no. 8, 67. https://doi.org/10.1007/s11886-017-0881-7
Siegel J, Pizzi MA, Brent Peel J, Alejos D, Mbabuike N, Brown BL et al. Update on Neurocritical Care of Stroke. Current Cardiology Reports. 2017 Aug 1;19(8). 67. https://doi.org/10.1007/s11886-017-0881-7
Siegel, Jason ; Pizzi, Michael A. ; Brent Peel, J. ; Alejos, David ; Mbabuike, Nnenne ; Brown, Benjamin L. ; Hodge, David ; David Freeman, W. / Update on Neurocritical Care of Stroke. In: Current Cardiology Reports. 2017 ; Vol. 19, No. 8.
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