Greg Albers, MD, and Stephan Mayer, MD, review strategies for preventing progression from large vessel occlusion to LHI. They discuss thrombectomy, clinical monitoring strategies, and key factors that inform the decision to perform a decompressive craniectomy.
Providing prompt feedback to the multidisciplinary stroke team on protocols and procedures may improve patient outcomes.
Goal: Train personnel to rapidly evaluate and stabilize patients1
FAST-ED, Field Assessment Stroke Triage for Emergency Destination; LAPSS, Los Angeles Prehospital Stroke Screen; RACE, Rapid Arterial Occlusion Evaluation.
1. Jauch et al. Stroke. 2013;44:870-947. 2. Kidwell et al. Stroke. 2000;31:71-76. 3. Pérez de la Ossa et al. Stroke. 2014;45:87-91. 4. Lima et al. Stroke. 2016;47:1997-2002.
Goal: Establish protocols to transfer patients to appropriate acute care facility5
5. Higashida et al. Stroke. 2013;44:2961-2984.
Goal: Assess clinical and neurological characteristics
CTP, computed tomography perfusion; DW-MRI, diffusion-weighted magnetic resonance imaging; LHI, large hemispheric infarction; LVO, large vessel occlusion; NCCT, noncontrast computed tomography; NIHSS, National Institutes of Health Stroke Scale.
1. Jauch et al. Stroke. 2013;44:870-947. 6. Kimberly and Sheth. Neurol Clin Pract. 2011;76(7 suppl 2):S50-S56. 7. Powers et al. Stroke. 2018;49:e46-e110. 8. Birenbaum et al. West J Emerg Med. 2011;12:67-76.
Goal: Prevent progression from LVO to LHI
DHC, decompressive hemicraniectomy; ICP, intracranial pressure; LHI, large hemispheric infarction; LVO, large vessel occlusion; NIHSS, National Institutes of Health Stroke Scale.
7. Powers et al. Stroke. 2018;49:e46-e110. 9. Torbey et al. Neurocrit Care. 2015;22:146-164. 10. Rahme et al. J Neurosurg. 2012;117:749-754. 11. Kasner. Lancet Neurol. 2006;5:603-612. 12. Weir et al. Q J Med. 2003;96:67-74. 13. Rowe. Brain Behav. 2017;7:e00771. 14. Wijdicks et al. Stroke. 2014;45:1222-1238. 15. Vahedi et al. Lancet Neurol. 2007;6:215-222.
Disclosure: All panelists received honoraria from Biogen for participation in this symposium.
Disclaimer: All of the information discussed today is for informational purposes only; does not constitute medical advice; and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment.