Endovascular Thrombectomy

Strokes are caused by a block in the blood supply to the brain which causes a decrease in oxygen and delivery of other important supplies which facilitate proper functioning. Fifteen million cases are reported worldwide annually, although not all of these cases are mortalities, the large prevalence of strokes ranks it as the fourth leading cause of death in the United States. (Figueroa) Because of the time sensitivity associated with the lack of resources to the brain, strokes are considered a medical emergency and early recognition of symptoms can help decrease the amount of damage caused . Although strokes do not always cause death, strokes most often leave the individual with some physical and cognitive impairment.

In professional experience working at a comprehensive stroke center, early intervention in crucial in decreasing the amount of deficits stroke victims acquire. As I further my education and professional status in the field of Nurse Practitioner, I will be able to participate in in-depth research related to cerebrovascular accidents and quality patient outcomes.

It is important that the type of stroke is diagnosed quickly to reduce the damage done to the brain and also to determine the right type of treatment because one treatment for one kind of stroke can be harmful to someone who has had a different kind. A number of different medications may be given at the hospital to help break up the clot and prevent the formation of new clots. For Ischemic stroke the treatment can begin with drugs to break down clots and prevent further ones from forming. Aspirin can be given, along with an injection of a tissue plasminogen activator (TPA). TPA works by dissolving clots but it needs to be injected within 4.5 hours of stroke symptoms once they have presented themselves. Hemorrhagic stroke treatment can begin with drugs being given to reduce the pressure in the brain, overall blood pressure, prevent seizures and prevent sudden constrictions of blood vessels.(http://www.mayoclinic.org/diseases-conditions/stroke/diagnosis-treatment/treatment/txc-20117296) Because strokes are life-changing events that can affect a person both physically and emotionally, temporarily or permanently. After a stroke,

Cerebral vascular accidents are also known as strokes. Strokes can cause minimal to severe brain damage which can affect a person’s quality of life. This paper covers the definition, signs and symptoms, treatments, causes, prevention and what a nursing assistant can do to help someone recovering from a stroke.

The stroke from a blocked artery is called ischemia, and the ruptured artery is hemorrhagic. As time is critical after the cerebrovascular accident, lack of treatment will lead to brain cell apoptosis and neural injuries are permanent. Evaluation using brief tests of cognitive impairment includes analysis of executive functioning, memory, language, and visuospatial performance, neuropsychiatric as well as depressive symptoms (Grant and Adams, 2009).

Treatment of stroke, in general and ischemic stroke specifically, in particular, is aone of the most pressing issues in both nursing and medical science today. This is due to the fact that there are very few available treatment options for the various kinds of stroke. Acute ischemic stroke carriesis a prominent medical issue with a high risk of death or morbidity (Kakma, Stofko, Binning, Liebman & Veznedaroglu, 2014). Stroke, including ischemic and other types, is recognized, further, as a one of the most prominent leading causes of disabilities (Saver et al., 2015). While cerebral infarction resulting from thrombotic occlusion of brain arteries is the most common stroke type, ischemic stroke is also quite common. Each year ischemic stroke affects over a half-million victims in the United States alone;. o Of this group, about 150,000 deaths occur, along with 300,000 victims suffering from any number of disabilities following a stroke (CITE)after the fact.

The third leading cause of death and leading cause of disability in American adults is a stroke. It is a medical emergency with an individual affected every 45 seconds in America. It occurs when there is an obstruction of blood flow caused by a ruptured blood vessel or blood clot resulting in depletions of oxygen supply to the brain. It results in a wide range of devastating effects depending on the affected brain part such as loss of speech, loss of thought process, loss of activities of daily living (ADL), or death. A stroke lasting for a few minutes is known as a Transient Ischemic Attach (TIA) or mini-stroke and if ignored can result in disability (Stroke, 2016). The American Heart Association (AHA), American Stroke Association (ASA), & Brain Attack Coalition (BAC) developed eight core measures for stroke (STK). These measures were approved by The Joint Commission (TJC) in 2009 for hospitals to become certified as a primary or comprehensive stroke center. The measures include Venous Thromboembolism (VTE) Prophylaxis; Discharged on Antithrombotic Therapy; Anticoagulation Therapy for

Stroke previously known as Cerebrovascular accident is well-defined as ‘an abrupt cessation of cerebral circulation in one or more of the blood vessels distributing the brain. Due to the interruption or diminish of oxygen supply causes serious damage or necrosis in the brain tissues (Jauch, Kissella & Stettler, 2005). There is a presence of one or more symptoms such as weakness or numbness or paralysis of the face, arm or leg, difficulty speaking or swallowing, dizziness, loss of balance, loss of vision, sudden blurring or decreased vision in one or both eyes and headache. Stoke is categorised into two types, Ischaemic and haemorrhagic

Delivering the earliest possible definitive treatment for acute ischemic stroke is the most primary goal of health care providers caring for stroke patients. In the United States, the use of fibrinolytics for ischemic stroke received Food and Drug Administration approval on June 18, 1996. Clinical demonstration presented that shorter time to fibrinolysis prominently enhanced clinical outcome in acute ischemic stroke patients. National Institute for Neurological Disorders and Stroke trials demonstrated that treatment within 3 hours of symptom onset is beneficial for patients with acute ischemic stroke. Even within the 3-hour window, benefit from fibrinolysis decreases as time from symptoms onset

Cerebrovascular diseases have a major impact on morbidity and mortality worldwide. Studies have shown that correcting carotid artery stenosis, a major cause of neurological disease, improves quality of life and increases survival time for patients. At present, effective carotid artery procedures are widely applied for symptomatic patients. According to suggestions by the American College of Cardiology Foundation and the American Heart Association in their 2011 management guidelines in extra-cranial carotid and vertebral artery disease patients, carotid artery stenting has a role as an alternative treatment in symptomatic patients who unsuitable for carotid endarterectomy (recommendation Class I, Level of Evidence: B). When the internal carotid artery stenosis is measured to be more than 70% by noninvasive imaging or more than 50% by catheter angiography, the anticipated rate of peri-procedural stroke and mortality is less than 6%1 for carotid stenting, which is comparable to carotid endarterectomy.

Assessment will determine and influence the choice of interventions. Deterioration in neurological signs or failure to improve after initial insult may reflect decreased intracranial adaptive capacity requiring patient to be transferred to critical area for monitoring of ICP, other therapies. If the stroke is evolving, patient can deteriorate quickly and require repeated assessment and progressive treatment. If the stroke is “completed,” the neurological deficit is nonprogressive, and treatment is geared toward rehabilitation and preventing recurrence.

Stroke is seen as a major health concern and this is due to the fact that every year, as many as 110,000 individuals suffers from strokes making it a key issue. (NHS 2014)

The choice of Brain imaging techniques is between CT and MRI imaging. At present there is no consensus to which is the best imaging modality. The European Stroke Organization recommends CT or MRI in all suspected stroke or Transient Ischemic Attack ( TIA) patients . In Ireland in almost all cases the preference in acute imaging of stroke is CT, because of the wider availability of CT and the ability of CT to very rapidly deliver the necessary images. MRI imaging for acute stroke requires in excess of 50 minutes of imaging time while CT images can be delivered within 3 to 4 minutes. MRI imaging is very useful for imaging TIA cases as it will commonly identify areas of ischemic stroke not visible on CT, and time is less critical

A 55-year-old white female with a past medical history significant for ischemic stroke of the right frontal cortex, multiple episodes of transient ischemic attack, hypertension, and temporal arteritis presented to the hospital for right carotid endarterectomy (CEA). Past surgical history was notable for bilateral encephaloduroarteriosyngiosis, right superficial temporal artery to middle cerebral artery bypass, coiling of aneurysms in the right

Stroke represents a public health issue that is affecting both developed and developing countries. A lot money and time have been invested in attempts to improve outcome in these patients. The majority of patients are treated with medical management. There are however few patients in which an occlusion of the middle cerebral artery (MCA) can lead to progressive edema, mass effect and herniation of the brain. As a consequence of this progressive rise in intracranial pressure surgical decompression of the cranium is often considered creating a role for the neurosurgeon in the management of stroke patients. I will present a case of a young boy with an underlying predisposing factor who presented with malignant progression of an MCA infarct, that required surgical intervention.