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DOI: 10.1055/s-0039-1694095
Intensive Care Management Following Endovascular Clot Retrieval for Acute Stroke: A Systematic Review of the Literature
Publication History
Received: 31 March 2019
Accepted after revision: 06 May 2019
Publication Date:
26 July 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00033348/201902/lookinside/thumbnails/10-1055-s-0039-1694095_00017-1.jpg)
Abstract
There has been an increase in the number of patients requiring ICU care following endovascular clot retrieval (ECR) for acute ischemic stroke (AIS). The authors’ objective was to systematically assess the evidence surrounding postprocedural care of ECR patients in critical care areas. A systematic literature review was conducted examining the critical care management of adult patients following ECR. The preliminary search results were sorted manually by two authors and conflicts were settled by consensus with a third reviewer. References of key papers were also reviewed for studies meeting the inclusion criteria. In addition, the authors sought to identify all relevant practice guidelines from major neurological and critical care societies. Study quality was assessed using the Newcastle Ottawa Quality Assessment Scale for cohort studies. Medline, Embase, Cochrane Central Register of Controlled Trials databases, Web of Science, and bibliographies of retrieved articles were searched. Studies were limited to human subjects and English language. Studies specific to the post ECR population were limited. In the initial Medline search, 3,882 papers were returned. A total of 16 studies met the inclusion criteria. There were also 10 practice guidelines from relevant scientific bodies. The level of evidence for postprocedural care was found to be variable and mostly based on expert opinion and data extrapolated from general stroke and postthrombolysis patients. There is limited evidence guiding the postprocedural care of ECR patients. Given the increase in both the availability and application of ECR, trials looking specifically at how best to care for this patient population are needed.
Keywords
mechanical thrombolysis - balloon embolectomy - thrombectomy - endovascular procedures - intracranial embolism - stroke - brain ischaemia - brain infarction - critical care - intensive care units-
References
- 1 Berkhemer OA, Fransen PS, Beumer D. et al. MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015; 372 (01) 11-20
- 2 Zaidi SF, Shawver J, Espinosa MoralesA. et al. Stroke care: initial data from a county-based bypass protocol for patients with acute stroke. J Neurointerv Surg 2017; 9 (07) 631-635
- 3 Wells G, Shea B, O'Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2018 [cited 2018 Dec 2018]; Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp Accessed June 21, 2019
- 4 Linares G, Polderman KH, Wechsler LR. et al. Abstract TP14: simultaneous endovenous hypothermia and intra-arterial thrombectomy for acute ischemic stroke is safe, feasible and does not require general anesthesia. Stroke 2013; 44 (Suppl. 01) ATP14
- 5 Khan Z, Nattanamai P, Keerthivaas P, Newey CR. An evaluation of complications in femoral arterial sheaths maintained post-neuroangiographic procedures. Cureus 2018; 10 (02) e2230
- 6 Gordon WR, Salamo RM, Behera A. et al. Association of blood glucose and clinical outcome after mechanical thrombectomy for acute ischemic stroke. Intervent Neurol 2018; 7 (03) (04) 182-188
- 7 Chang A, Llinas EJ, Chen K, Llinas RH, Marsh EB. Shorter intensive care unit stays?. The majority of post-intravenous tPA (tissue-type plasminogen activator) symptomatic hemorrhages occur within 12 hours of treatment. Stroke 2018; 49 (06) 1521-1524
- 8 Akpinar CK, Gurkas E, Aytac E. Moderate to severe anemia is associated with poor functional outcome in acute stroke patients treated with mechanical thrombectomy. Intervent Neurol 2018; 7 (01) (02) 12-18
- 9 Ritzenthaler T, Cho TH, Mechtouff L. et al. Cerebral near-infrared spectroscopy: a potential approach for thrombectomy monitoring. Stroke 2017; 48 (12) 3390-3392
- 10 Mistry EA, Mistry AM, Nakawah MO. et al. Systolic blood pressure within 24 hours after thrombectomy for acute ischemic stroke correlates with outcome. J Am Heart Assoc 2017; 6 (05) 18
- 11 Hwang YH, Jeon JS, Kim YW, Kang DH, Kim YS, Liebeskind DS. Impact of immediate post-reperfusion cooling on outcome in patients with acute stroke and substantial ischemic changes. J Neurointerv Surg 2017; 9 (01) 21-25
- 12 Goyal N, Tsivgoulis G, Pandhi A. et al. Blood pressure levels post mechanical thrombectomy and outcomes in large vessel occlusion strokes. Neurology 2017; 89 (06) 540-547
- 13 Dehkharghani S, Bowen M, Haussen DC. et al. Body temperature modulates infarction growth following endovascular reperfusion. AJNR Am J Neuroradiol 2017; 38 (01) 46-51
- 14 Nikoubashman O, Schürmann K, Probst T. et al. Clinical impact of ventilation duration in patients with stroke undergoing interventional treatment under general anesthesia: the shorter the better?. AJNR Am J Neuroradiol 2016; 37 (06) 1074-1079
- 15 Martins AI, Sargento-Freitas J, Silva F. et al. Recanalization modulates association between blood pressure and functional outcome in acute ischemic stroke. Stroke 2016; 47 (06) 1571-1576
- 16 Jeong HG, Kim BJ, Yang MH, Han MK, Bae HJ, Lee SH. Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment. Neurology 2016; 87 (10) 996-1002
- 17 Horn CM, Sun CH, Nogueira RG. et al. Endovascular reperfusion and cooling in cerebral acute ischemia (ReCCLAIM I). J Neurointerv Surg 2014; 6 (02) 91-95
- 18 Jung S, Schindler K, Findling O. et al. Adverse effect of early epileptic seizures in patients receiving endovascular therapy for acute stroke. Stroke 2012; 43 (06) 1584-1590
- 19 Natarajan SK, Dandona P, Karmon Y. et al. Prediction of adverse outcomes by blood glucose level after endovascular therapy for acute ischemic stroke. J Neurosurg 2011; 114 (06) 1785-1799
- 20 Restrepo L, Bang OY, Ovbiagele B. et al. Impact of hyperlipidemia and statins on ischemic stroke outcomes after intra-arterial fibrinolysis and percutaneous mechanical embolectomy. Cerebrovasc Dis 2009; 28 (04) 384-390
- 21 Howick J, Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M. Oxford Centre for Evidence-based Medicine–Levels of Evidence. 2009 March 2009 [cited 2018 Nov 11]; Available from: https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/ Accessed June 20, 2019
- 22 Torbey MT, Bösel J, Rhoney DH. et al. Evidence-based guidelines for the management of large hemispheric infarction: a statement for health care professionals from the Neurocritical Care Society and the German Society for Neuro-intensive Care and Emergency Medicine. Neurocrit Care 2015; 22 (01) 146-164
- 23 Powers WJ, Rabinstein AA, Ackerson T. et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (03) e46-e110
- 24 Powers WJ, Derdeyn CP, Biller J. et al; American Heart Association Stroke Council. 2015; American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2015; 46 (10) 3020-3035
- 25 Nyquist P, Bautista C, Jichici D. et al. Prophylaxis of venous thrombosis in neurocritical care patients: an evidence-based guideline: a statement for healthcare professionals from the Neurocritical Care Society. Neurocrit Care 2016; 24 (01) 47-60
- 26 Leslie-Mazwi T, Chen M, Yi J. et al; Standards and Guidelines committee of the Society of NeuroInterventional Surgery (SNIS). Post-thrombectomy management of the ELVO patient: guidelines from the Society of NeuroInterventional Surgery. J Neurointerv Surg 2017; 9 (12) 1258-1266
- 27 Australian Clinical Guidelines for Stroke Management. Stroke Foundation: acute medical and surgical management. Australia: 2017
- 28 Dennis M, Caso V, Kappelle LJ, Pavlovic A, Sandercock P. European Stroke Organisation (ESO) guidelines for prophylaxis for venous thromboembolism in immobile patients with acute ischemic stroke. European Stroke Journal 2016; 1 (01) 6-19
- 29 Fuentes B, Ntaios G, Putaala J, Thomas B, Turc G, Díez-Tejedor E. European Stroke Organisation (ESO) guidelines on glycaemia management in acute stroke. European Stroke Journal 2018; 3 (01) 5-21
- 30 National Institute for Health and care Excellence. Mechanical clot retrieval for treating acute ischaemic stroke. London: NICE Guidelines-Interventional Procedures Guideline; 2016
- 31 ANZCOR Guideline 9.2.2. Stroke. 2016 Available at https://resus.org.au/guidelines/ Accessed June 20, 2019
- 32 National Institute for Health and care Excellence. Stroke in adults London: NICE Guidelines-Quality Standard; 2010
- 33 National Institute for Health and care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. London: NICE Guidelines - Clinical Guideline; 2008
- 34 Ntaios G, Dziedzic T, Michel P. European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke. Int J Stroke 2015; 10 (06) 941-949 2015
- 35 Holtkamp M, Beghi B, Benninger F. et al. European Stroke Organisation guidelines for the management of post-stroke seizures and epilepsy. Int J Stroke 2017; 2 (02) 103-115
- 36 National Institute for Health and Care Excellence. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. 2008 [cited 2018 November]; Available from: nice.org.uk/guidance/cg68 Accessed June 20, 2019
- 37 White PM, Bhalla A, Dinsmore J. et al. Standards for providing safe acute ischaemic stroke thrombectomy services (September 2015). Clin Radiol 2017; 72 (02) 175.e1-175.e9
- 38 Clinical Guidelines for Stroke Management in Clinical Guidelines for Stroke Management. Stroke Foundation: acute medical and surgical management. Australia: 2017
- 39 Talke PO, Sharma D, Heyer EJ, Bergese SD, Blackham KA, Stevens RD. Society for neuroscience in anesthesiology and critical care expert consensus statement: anesthetic management of endovascular treatment for acute ischemic stroke*: endorsed by the Society of NeuroInterventional Surgery and the Neurocritical Care Society. J Neurosurg Anesthesiol 2014; 26 (02) 95-108
- 40 Abelson M, Roos J. Mechanical embolectomy for large vessel ischemic strokes: a cardiologist's experience. Catheter Cardiovasc Interv 2010; 76 (03) 309-315
- 41 Evans MRB, White P, Cowley P, Werring DJ. Revolution in acute ischaemic stroke care: a practical guide to mechanical thrombectomy. Pract Neurol 2017; 17 (04) 252-265
- 42 Seder DB, Mayer SA. Critical care management of subarachnoid hemorrhage and ischemic stroke. Clin Chest Med 2009; 30 (01) 103-122 viii–ix
- 43 Figueroa SA, Zhao W, Aiyagari V. Emergency and critical care management of acute ischaemic stroke. CNS Drugs 2015; 29 (01) 17-28
- 44 Kirkman MA, Citerio G, Smith M. The intensive care management of acute ischemic stroke: an overview. Intensive Care Med 2014; 40 (05) 640-653
- 45 Al-Mufti F, Dancour E, Amuluru K. et al. Neurocritical care of emergent large-vessel occlusion: the era of a new standard of care. J Intensive Care Med 2017; 32 (06) 373-386
- 46 Patel VN, Gupta R, Horn CM, Thomas TT, Nogueira RG. The neuro-critical care management of the endovascular stroke patient. Curr Treat Options Neurol 2013; 15 (02) 113-124
- 47 Bevers MB, Kimberly WT. Critical care management of acute ischemic stroke. Curr Treat Options Cardiovasc Med 2017; 19 (06) 41
- 48 Shah VA, Martin CO, Hawkins AM, Holloway WE, Junna S, Akhtar N. Groin complications in endovascular mechanical thrombectomy for acute ischemic stroke: a 10-year single center experience. J Neurointerv Surg 2016; 8 (06) 568-570
- 49 Hill M, Glenn BA, Reese BJ, Morrow B. Recommendations for endovascular care of stroke patients. Intervent Neurol 2018; 7 (01) (02) 65-90
- 50 de Carvalho FA, de Figueiredo MM, Silva GS. Acute stroke: postprocedural care and management of complications. Tech Vasc Interv Radiol 2012; 15 (01) 78-86