Briefly describe the indications, post-procedure management and procedural complications of endovascular clot retrieval (ECR) for acute stroke.

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College answer


Briefly, they said.

  • Indications:
    • Ischaemic stroke with large vessel occlusion
    • Substantial neurological deficit, NIHSS ≥ 5
    • Timeframe criteria:
      • Less than six hours: "broad clinical and imaging criteria"
      • 6-24 hour window: "significant volume of salvageable tissue"
    • Good level of premorbid independence
  • Complications:
    • Bleeding (though the risk of symptomatic ICH is no higher)
    • Cerebral oedema
    • Vascular access site complications
  • Evidence:
    • ​​​​​​​DAWN trial: 206 patients, 49% had good functional outcome vs 13%
    • DEFUSE-3 trial: 186 patients, 47% had good functional outcome vs 17%
  • Post-procedure management:
  1. E​​​​​​xtubate early, if able.
  2.  Mechanical ventilation focuses on maintenance of normoxia and normocapnia
  3. Blood pressure control:
    1. Aim for SBP <140-160 for fully revascularised patients
    2. Aim for MAP 10-20% over normal baseline and SBP <185 for partially revascularised patients
  4. Minimise sedation and maximise the opportunity for regular reassessment
    Also, scan their head after the first 24 hrs.
  5. Control of electrolytes to prevent AF
  6. Maintenance of neutral fluid balance
  7. Glucose control: hyperglycaemia is harmful
  8. Antiplatelets after 24 hrs (earlier if they had an endovascular stent)
  9. Fever is harmful: paracetamol is recommended



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