Presented on April 5, 2019
Presented by Lora Cheek RN, SCRN – University of Maryland Medical Center

Current NIR Stroke research has produced multiple strong studies supporting the endovascular treatment of acute stroke in up to a 6 hour window or longer depending on imaging. Intraarterial mechanical thrombectomy done in Neuro IR is used to improve the recanalization rate of cerebral vessels in a patient experiencing an acute stroke. Presently, standard treatment with IV tPA results in 1 in 5 patients having a good outcome, but with the MR CLEAN study 1 in 3 patients who received IV tPA and endovascular intervention with the newest devices had a good outcome. General anesthesia with intubation and moderate sedation are the two most frequently used anesthetic approaches for patients with an acute ischemic stroke undergoing endovascular treatment. Recent studies published indicate that patients undergoing endovascular treatment of acute ischemic stroke have a safer and better outcome at three months than those managed with general anesthesia. A cooperative and stationary patient is optimal in the prevention of intra-procedural and device-related complications such as dissection, perforation and distal embolization. There is currently much discussion and some controversy regarding the choice to use moderate sedation verses general anesthesia for patients undergoing endovascular treatment for acute stroke. Some of the crucial issues in the debate are time delay to recanalization, intra-procedural hemodynamic changes and patient safety. While Clinical trials
are now underway to address these issues, the most recent recommendations from the 2015 American Heart Association/American Stroke Association state that it might be reasonable to favor conscious sedation over general anesthesia during endovascular therapy for AIS. 

Every Nurse has a passion and mine Lora’s is the care and treatment of the neurologically compromised patient. From the Neuro ICU to Stroke Coordinator to Neuro IR she has been involved in the Treatment of Stroke patients for over 24 years and she still finds that the treatment of acute stroke has been a dynamic, super exciting, ever evolving process. Current new research has produced 5 new strong Thrombectomy trials and will definitely have an impact on the acute
treatment of Stroke in America.