Stroke Management: Stroke Care Management

Stroke is a condition in which a blood vessel in the brain ruptures, causing internal bleeding or a blocked blood supply to the brain.

This leads to a lack of oxygen and blood in the brain tissue, and if there is a lack of oxygen, brain cells begin to die within minutes.

Stroke management

Symptoms of stroke are likely to occur in a person when there is damage to the tissues of the brain.

Below are some of the symptoms:

• Vision problems
• confusion
• Trouble walking
• paralysis
• dizziness
• Loss of balance

Treating stroke is important as it can protect the person from other associated risk factors. The first step in stroke management is ambulance service, which starts in the hospital and includes the Stroke System of Care. This step is to stabilize a person, which consists of laboratory tests and imaging in a short period of time. The step is performed to evaluate and assess the patient’s condition. If a critical condition occurs, this includes various tests such as blood pressure control, the need for intubation, or the need for thrombolytic intervention.

Some of the key goals of stroke emergency management are:

• Prevent progression and cell death
• Restoration of cerebral blood flow
• Restore the patient’s function to optimal levels before the stroke. Reduce neurological deficits
• Support vital functions

Stroke management algorithms

Emergency services and acute hospitals often use different algorithms to effectively treat stroke and provide them with better treatments. The Stroke Triage Algorithm was developed by the American Heart Association, which includes crews with an ambulance and is equipped with the best tools for detecting stroke and assessing the patient’s condition. It also helps in determining the right hospital according to treatment needs.

Imaging

Patients with neurological symptoms should be identified immediately with brain imaging. The following are the symptoms for having brain imaging performed:

• Depressed state of consciousness
• Anticoagulant treatment
• fever
• Strong headache
• Bleeding tendency

Brain imaging should be performed within 24 hours of symptoms appearing in patients who do not have the above indications.

Recommendations for level 1 clinical guidelines

• A non-augmented CT scan of the brain will provide the necessary information about further emergency management-related decisions. Emergency brain imaging is recommended before starting acute stroke treatment.
• When considering endovascular therapy, a non-invasive intracranial vascular examination is usually recommended. According to the guidelines of the medical associations, non-invasive vascular imaging should be performed prior to intravenous r-tPA.

Ischemic stroke

In ischemic stroke, the clot is broken down using either a drug called thrombolysis or a mechanical method called thrombectomy. Other patient conditions should be monitored, such as blood sugar levels, oxygen levels, and any required treatments. Patients experiencing acute ischemic stroke should be treated immediately within 3-4.5 hours of the onset of symptoms.

Thrombolysis

Patients are given tissue plasminogen activator (tPA), a drug that dissolves in blood clots and is given into the arm vein through a catheter. This is the early step in the management of ischemic acute stroke.

However, this drug should be used in moderate amounts and with careful consideration as it involves risks and complications such as symptomatic intracranial bleeding at a rate of 5.2%. Guidelines under this drug are that patients should receive tPA intravenously even if they are undergoing endovascular treatment.

Endovascular Therapy

In this therapy, a blood clot is physically removed using a mechanical thrombectomy or a catheter-based drug procedure. According to the researchers, this method has shown positive results. Certain clot removal devices are used in endovascular treatments and include:

• The penumbra thrombectomy system: In this system, the clot is removed from large intracranial vessels by suction.
• Mechanical embolus removal in the thrombectomy system with cerebral ischemia: In this method, a snare is used to remove a clot through a small catheter.
• The Solitaire Flow Restoration Device and Trevo Retriever Device: This method bypasses the clot and restores flow and maintains a clot.

Recommendations for level 1 clinical guidelines

If patients meet the following criteria, they should endovascular therapy:

• The pre-stroke mRS score is between 0 and 1.
• Age is 18 or older.
• NIHSS score 6 or higher
• ASPECTS of 6 or higher
• Start treatment within 6 hours of the onset of symptoms.

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