Briefly describe the indications, post-procedure management and procedural complications of endovascular clot retrieval (ECR) for acute stroke.
Briefly, they said.
- 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
- Bleeding (though the risk of symptomatic ICH is no higher)
- Cerebral oedema
- Vascular access site complications
- Post-procedure management:
- Extubate early, if able.
- Mechanical ventilation focuses on maintenance of normoxia and normocapnia
- Blood pressure control:
- Aim for SBP <140-160 for fully revascularised patients
- Aim for MAP 10-20% over normal baseline and SBP <185 for partially revascularised patients
- Minimise sedation and maximise the opportunity for regular reassessment
Also, scan their head after the first 24 hrs.
- Control of electrolytes to prevent AF
- Maintenance of neutral fluid balance
- Glucose control: hyperglycaemia is harmful
- Antiplatelets after 24 hrs (earlier if they had an endovascular stent)
- Fever is harmful: paracetamol is recommended
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