ICU SAQs · Neurocritical care / vascular
Acute ischaemic stroke — thrombolysis and thrombectomy
A CICM SAQ on the acute ischaemic stroke within both windows — the IV thrombolysis (alteplase 0.9 mg/kg within 4.5 h), the mechanical thrombectomy (M1 LVO within 6 h), the BP control under 180/105, and the post-stroke ICU care.
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Prompt
A 68-year-old presents 2 hours after a sudden onset of a right-sided weakness and an aphasia. The NIHSS is 16. The CT shows no haemorrhage. The CT angiogram shows a left M1 middle cerebral artery occlusion. Outline the acute management.
Question
A 68-year-old presents 2 hours after a sudden onset of a right-sided weakness and an aphasia. The NIHSS is 16. The CT shows no haemorrhage. The CT angiogram shows a left M1 middle cerebral artery occlusion. Outline the acute management.[1]
References5ShowHide
- [1]Hacke W, Kaste M, Bluhmki E, et al Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke N Engl J Med, 2008.PMID 18815396
- [2]Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke N Engl J Med, 2015.PMID 25517348
- [3]Gorelick PB, Qureshi S, Farooq MU Management of blood pressure in stroke Int J Cardiol Hypertens, 2019.PMID 33447751
- [4]Vahedi K, Hofmeijer J, Juettler E, et al. Early decompressive surgery in malignant infarction of the middle cerebral artery: a pooled analysis of three randomised controlled trials Lancet Neurol, 2007.PMID 17303527
- [5]Dennis M, Sandercock P, Reid J, et al. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3) Lancet, 2013.PMID 23727163