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Acute Ischemic Stroke

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Evidence-Based Critical Care

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Abstract

Stroke causes 9 % of all deaths worldwide and is the second most common cause of death after ischemic heart disease. In over 75 % of cases the stroke is ischemic in nature. However, unlike acute myocardial infarction, therapeutic interventions which attempt to limit infarct size have been of limited success. Only two interventions in a small subset of patients (less than 5 % of AIS patients) have been demonstrated to improve the outcome of patients suffering an acute ischemic stroke (AIS). The single most important intervention to alter the natural history of AIS and improve the patients’ functional outcome is the administration of a thrombolytic agent (intravenous rt-PA) in the appropriate patient within the narrow 3–4.5 h window [1]. Endovascular therapy represents an alternative therapy to intravenous rt-PA in patients who are not candidates for intravenous rt-PA, but has no advantage over intravenous rt-PA [2]. Hemispheric decompression in patients less than 60 years of age with malignant middle-cerebral-artery-territory infarction and space occupying brain edema has been demonstrated to improve outcome. An individual patient meta-analysis demonstrated a marked improvement in neurological recovery and survival with decompressive craniectomy [3]. Despite initial enthusiasm, neuroprotective agents have failed to show a benefit in the management of AIS [4, 5], as has tight glycemic control [6], high dose albumin [7], and the use of anti-hypertensive agents [8–11]. Considering this data, the rationale for admitting patients to an ICU needs to be evaluated. Furthermore, aspects of medical care which maximize the potential for recovery and limit complications need to be explored. In most instances such treatment is best provided by specialized “low-technology” Stroke Units.

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  1. Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA

    Paul Ellis Marik

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Marik, P.E. (2015). Acute Ischemic Stroke. In: Evidence-Based Critical Care. Springer, Cham. https://doi.org/10.1007/978-3-319-11020-2_42

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  • DOI: https://doi.org/10.1007/978-3-319-11020-2_42

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