title: Neurocritical Care of Emergent Large-Vessel Occlusion: The Era of a New Standard of Care.
abstract: Acute ischemic stroke continues to be one of the leading causes of morbidity and mortality worldwide. Recent advances in mechanical thrombectomy techniques combined with prereperfusion computed tomographic angiography for patient selection have revolutionized stroke care in the past year. Peri- and postinterventional neurocritical care of the patient who has had an emergent large-vessel occlusion is likely an equally important contributor to the outcome but has been relatively neglected. Critical periprocedural management issues include streamlining care to speed intervention, blood pressure optimization, reversal of anticoagulation, management of agitation, and selection of anesthetic technique (ie, general vs monitored anesthesia care). Postprocedural critical care issues that might modulate neurological outcome include blood pressure and glucose optimization, avoidance of fever or hyperoxia, fluid and nutritional management, and early integration of rehabilitation into the intensive care unit setting. In this review, we sought to lay down an evidence-based strategy for patients with acute ischemic stroke undergoing emergent endovascular reperfusion.
authors.affiliation: 1 Department of Neurology, Columbia University Medical Center, Neurological Institute of New York, New York, NY, USA.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: 1 Department of Neurology, Columbia University Medical Center, Neurological Institute of New York, New York, NY, USA.
authors.forename: Elie
authors.initials: E
authors.lastname: Dancour
authors.affiliation: 2 Department of Neurosurgery and Neuroscience; Rutgers University School of Medicine, Newark, NJ, USA.
authors.forename: Krishna
authors.initials: K
authors.lastname: Amuluru
authors.affiliation: 2 Department of Neurosurgery and Neuroscience; Rutgers University School of Medicine, Newark, NJ, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Prestigiacomo
authors.affiliation: 3 Departments of Neurology and Neurosurgery, Ichan School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
authors.affiliation: 4 Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: 5 Departments of Neurology and Neurosurgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
authors.affiliation: 1 Department of Neurology, Columbia University Medical Center, Neurological Institute of New York, New York, NY, USA.
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey
authors.affiliation: 6 Departments of Neurosurgery and Radiology; Columbia University Medical Center, New York, NY, USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D003422:Critical Care; D057510:Endovascular Procedures; D019317:Evidence-Based Medicine; D006801:Humans; D059906:Neuroimaging; D018579:Patient Selection; D011182:Postoperative Care / Q000379:methods; D011300:Preoperative Care / Q000379:methods; D015424:Reperfusion / Q000379:methods; D059039:Standard of Care; D020521:Stroke / Q000000981:diagnostic imaging; D015912:Thrombolytic Therapy
keywords: acute ischemic stroke; mechanical thrombectomy; neurocritical care management