Presentation on theme: "Advanced Treatment Options for Stroke Patients Vickie Gordon PhD, ACNP-BC, CNRN."— Presentation transcript:
Advanced Treatment Options for Stroke Patients Vickie Gordon PhD, ACNP-BC, CNRN
Stroke Stroke is the rapidly developing loss of brain function(s) due to interruption in the blood supply to the brain and can result in permanent neurological damage. Two Types –Ischemic Stroke –Hemorrhagic Stroke
Limitations of IV rtPA Generalizability –4% utilization of rtPA –25% present within 3 hours: 29% eligible Major strokes are difficult –Baseline NIHSS >10 or dense MCA sign predicted poor clinical outcome –Large vessel recanalization rate low. Increased risk of sICH with larger strokes
Recanalization Acute Ischemic Stroke: Endovascular Treatment Contra indication to IV rtPA No change in NIHSS score one hour following administration of IV rtPA 3 hour treatment window has expired but less than 10 hours Severe neurological deficits (NIHSS>16) –Evidence of major cervical or intracranial vessel occlusion
Recanalization Acute Ischemic Stroke: Endovascular Treatment Treatment within 8 hours; longer in some cases (posterior circulation). IV/IA rtPA Merci Retrieval Device (FDA approved) Penumbra Aspiration Device (FDA approved)
Endovascular Treatment Femoral or radial access Series of catheters –Sheath –Guide Catheter –Micro catheter Wire navigation
Biplane and 3D reconstruction
Intra-Arterial rtPA Treatment rtPA into the thrombus
Intracranial Aneurysm Rupture Treatment options –Surgical clipping –Endovascular embolization (coiling) Goal is to exclude the aneurysm from the cerebral circulation and prevent rupture or re rupture while not producing adverse neurological outcomes.
Coil Embolization Balloon-assisted –Temporary inflation of the balloon in the parent artery during coil positioning. Advantage no permanent device left in artery. Disadvantage: temporary occlusion with each coil. Stent-assisted –Deployment in the parent artery acts as a scaffold for the coils. Advantage: no temporary occlusion. Disadvantage: requires anti platelet therapy.