Ischemic Stroke Patient Case Study

Introduction

We have not yet completed clinical hours for primary care so I am using a compilation of examples from work. I currently work in the emergency department in Minot, ND and we often care for ischemic stroke patients. Determining when the stroke symptoms began is one of the most important and most challenging questions to answer. Some patients wake up with stroke symptoms, some have a witnessed incident, and some are found after an unknown amount of time. Depending on the timetable, and whether or not patients meet criteria determines whether the patient will be treated with intravenous tPA or mechanical removal of the clot or tPA placed specifically on the clot via intra-arterial access. I decided to compare mechanical removal with

These methods have been thoroughly researched on their own but a comparison study with similar patient populations would be the best way to show which method has better patient outcomes. The studies reviewed in this paper used patients of different acuity but had similar results. I think this means mechanical removal of the clot could be more efficacious that intravenous tPA in lower acuity stroke patients. I could not find research on this specific subject for comparison. I don’t often see patients past the point of initial treatment; therefore I don’t know the outcomes. I have seen many patients undergo each type of treatment for ischemic stroke, some begin to show improvement within the first hour of beginning tPA treatment in the ER. Without more research, I will continue to follow the AHA/ASA guidelines for tPA treatment in my clinical practice. References

del Zoppo, G., Saver, J., Jauch, E., & Adams, H. (2009). Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue

Plasminogen Activator. AHA/ASA Science Advisory (40), 2945-2948.

Lansberg, M., Bluhmki, E., & Thijs, V. (2009). Efficacy and Safety of Tissue

Plasminogen Activator 3 to 4.5 Hours After Acute Ischemic Stroke. Journal of the American Heart Association (40), 2438-2441.

Smith, W., Sung, G., Starkman, S., Saver, J., Kidwell, C., Gobin, P., et al. (2005). Safety and Efficacy of Mechanical Embolectomy in Acute Ischemic Stroke. Journal of the American Heart Association (36),