Evaluation and Treatment of Acute Ischemic Stroke in Cardiac Care Unit – 5 years` Experience

Background: The goal for the emergent management of acute ischemic stroke (IS) is to minimize the brain damage. Patients with suspected IS are evaluated in the Emergency Department by the physician and neurologist consultant. Our center lack a neurology department and neurointervention (NI) facilities. Patients without indication for reperfusion are admitted to internal ward. When indicate, patients are either transfer to a tertiary center for ICNI, or admitted to a cardiac intensive care unit (CICU) for treatment with tissue plasminogen activator (tPA). Before initiation of the tPA, the cardiologist quickly re-evaluates the patient, and initiates the thrombolysis.

Aim: to evaluate the strategy and outcome of patients admitted to our CICU after having suffered a cerebrovascular accident (CVA) for therapeutic interventions

Methods and Results: during the years 2010-2015 a total amount of 73 patients with suspected acute CVA, no intracranial bleeding in brain CT, and neurologist recommendation for thrombolysis where hospitalized in our CICU. Twenty six of them where females. The average age was 64.4±12 years.

In 8 patient the thrombolysis was not given, due to improvement of the neurological status (4 patients), uncontrolled hypertension (1 patient), or decision to transfer the patient to a center with neuro intervention facilities (3 patients).

Four of the patients who received the tPA, but no improvement was seen, were transfered for NI.

Of the 10 patients who were transferred, only six underwent the catheterization, in 3 of them angiographic successfully.

During the study period, an emergency intracranial intervention was done by a cardiologist in the cardiac intervention laboratory, with 2/3 technical success.

Conclusion: Acute stroke with the need for prompt evaluation and treatment is common in the CICU, necessitated intensive care cardiologist to practice and to continue an educational programs in emergency neurology