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Update on Neurocritical Care of Stroke

  • Stroke (JF Meschia, Section Editor)
  • Published:
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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.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Department of Neurology, Mayo Clinic, 4500 San Pablo Road,, Jacksonville, FL, 32224, USA

    Jason Siegel, Michael A. Pizzi, J. Brent Peel & W. David Freeman

  2. Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL, USA

    Jason Siegel, Michael A. Pizzi, David Alejos & W. David Freeman

  3. Research Trainee Program, Mayo Clinic, Jacksonville, FL, USA

    David Alejos

  4. Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA

    Nnenne Mbabuike, Benjamin L. Brown & W. David Freeman

  5. Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA

    David Hodge

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Correspondence to Jason Siegel.

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Jason Siegel, Michael A. Pizzi, J. Brent Peel, David Alejos, Nnenne Mbabuike, Benjamin L. Brown, David Hodge, and W. David Freeman declare that they have no conflict of interest.

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Siegel, J., Pizzi, M.A., Brent Peel, J. et al. Update on Neurocritical Care of Stroke. Curr Cardiol Rep 19, 67 (2017). https://doi.org/10.1007/s11886-017-0881-7

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