RT Journal Article
SR Electronic
T1 Initial hospital management of patients with emergent large vessel occlusion (ELVO): report of the standards and guidelines committee of the Society of NeuroInterventional Surgery
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP 316
OP 323
DO 10.1136/neurintsurg-2015-011984
VO 9
IS 3
A1 Ryan A McTaggart
A1 Sameer A Ansari
A1 Mayank Goyal
A1 Todd A Abruzzo
A1 Barb Albani
A1 Adam J Arthur
A1 Michael J Alexander
A1 Felipe C Albuquerque
A1 Blaise Baxter
A1 Ketan R Bulsara
A1 Michael Chen
A1 Josser E Delgado Almandoz
A1 Justin F Fraser
A1 Donald Frei
A1 Chirag D Gandhi
A1 Don V Heck
A1 Steven W Hetts
A1 M Shazam Hussain
A1 Michael Kelly
A1 Richard Klucznik
A1 Seon-Kyu Lee
A1 Thabele Leslie-Mawzi
A1 Philip M Meyers
A1 Charles J Prestigiacomo
A1 G Lee Pride
A1 Athos Patsalides
A1 Robert M Starke
A1 Peter Sunenshine
A1 Peter A Rasmussen
A1 Mahesh V Jayaraman
YR 2017
UL http://jnis.bmj.com/content/9/3/316.abstract
AB Objective To 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.Methods Using 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.Results This 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.Conclusions Patients 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.