Time is Brain: The Future for Acute Ischemic Stroke Management is the Utilization of Steerable Microcatheters for Reperfusion

Background and ObjectivesMultidisciplinary acute stroke teams improve acute ischemic stroke management but may hinder trainees’ education which in turn may contribute to poorer outcomes in community hospitals upon graduation. Our goal was to assess graduate neurology trainee performance independent of a multi-disciplinary stroke team in the management of acute ischemic stroke, tissue plasminogen activator (tPA)-related hemorrhage, and cerebral herniation syndrome.MethodsIn this prospective, observational, single-center simulation-based study, participants (sub-interns to attending physicians) managed a patient with acute ischemic stroke followed by tPA-related hemorrhagic conversion leading to cerebral herniation. Critical actions were developed by a modified Delphi approach based on relevant American Heart Association guidelines and the Neurocritical Care Society’s Emergency Neurological Life Support protocols. The primary outcome measure was graduate neurology trainees’ critical action item sum score. We sought validity evidence to support our findings by comparing trainees’ performance across four levels of training.ResultsFifty-three trainees (including 31 graduate neurology trainees) and five attending physicians completed the simulation. The mean sum of critical actions completed by graduate neurology trainees was 15/22 (68%). Ninety percent of graduate neurology trainees properly administered tPA, 84% immediately stopped tPA infusion following patient deterioration, but only 55% reversed tPA according to guidelines. There was a moderately strong effect of level of training on critical action sum score (level 1 mean score [standard deviation (SD)] = 7.2 (2.8) vs. level 2 mean score (SD) = 12.3 (2.6) vs. level 3 mean score (SD) = 13.3 (2.2) vs. level 4 mean score (SD) = 16.3 (2.4), p < .001, R2 = 0.54).DiscussionGraduate neurology trainees reassuringly perform well in initial management of acute ischemic stroke, but frequently make errors in the treatment of hemorrhagic transformation after thrombolysis, suggesting the need for more education surrounding this low frequency, high-acuity event. High-fidelity simulation holds promise as an assessment tool for acute stroke management performance.

Download Full-text

Endovascular treatment for the acute ischemic stroke: the past and the future

AME Medical Journal ◽

10.21037/amj.2017.12.11 ◽

2018 ◽

Vol 3 ◽

pp. 15-15

Author(s):

Rui Liu ◽

Wei Li ◽

Erwin Stolz

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

The Past ◽

The Future

Download Full-text

Diagnostic imaging for acute ischemic stroke management

Expert Review of Medical Devices ◽

10.1586/17434440.3.1.113 ◽

2006 ◽

Vol 3 (1) ◽

pp. 113-126 ◽

Cited By ~ 4

Author(s):

Eric Jüttler ◽

Jochen B Fiebach ◽

Peter D Schellinger

Keyword(s):

Ischemic Stroke ◽

Diagnostic Imaging ◽

Acute Ischemic Stroke ◽

Stroke Management

Download Full-text

Stroke Management: Nursing Roles

Advances in Bioscience and Clinical Medicine ◽

10.7575/aiac.abcmed.ca1.49 ◽

2017 ◽

pp. 49

Author(s):

Maryam Esmaeili

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Acute Stroke ◽

Acute Ischemic Stroke ◽

Key Management ◽

Initial Phase ◽

Fluid Management ◽

Pressure Control ◽

Stroke Management ◽

Neurologic Symptoms

Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms.Methods: This is a review paper that report up to date finding with review some research papers and databases.Results: Sudden loss of focal brain function is the core feature of the onset of ischemic stroke. However, patients with conditions other than brain ischemia may present in a similar fashion. The goals in the initial phase include: ensuring medical stability, with particular attention to airway, breathing, and circulation, quickly reversing any conditions that are contributing to the patient's problem, determining if patients with acute ischemic stroke are candidates for thrombolytic therapy, moving toward uncovering the pathophysiologic basis of the patient's neurologic symptoms. Time is of the essence in the hyperacute evaluation of stroke patients. In addition to stabilization of airway, breathing, and circulation, and rapid neurologic evaluation, early key management issues that often arise in acute stroke include blood pressure control, fluid management, treatment of abnormal blood glucose levels, swallowing assessment and treatment of fever and infection. Care in a dedicated stroke unit is associated with better outcomes.Conclusion: The main goals in the initial phase of acute stroke management are to ensure medical stability, to quickly reverse conditions that are contributing to the patient's problem, to determine if patients with acute ischemic stroke are candidates for thrombolytic therapy, and to begin to uncover the pathophysiologic basis of the neurologic symptoms.

Download Full-text