Nursing Care for Patients with Acute Ischemic Stroke who are Treated with Mechanical Thrombectomy

Abstract

Acute ischemic stroke is a severe neurological condition characterized by the sudden destruction of brain tissue. It results in sudden neurological disorders, high mortality and is a leading cause of severe disability. Emergency endovascular treatment is an important therapeutic approach for reducing complications, disability, and mortality. This approach is particularly indicated for patients with acute ischemic stroke involving large vessel occlusion or for those with contraindications to intravenous thrombolytic therapy. The optimal time window for treatment is within 6 hours after symptom onset.

This case study involved a 39-year-old obese Thai female patient. The patient was admitted with major symptoms that began 1 hour prior to hospital presentation, including slurred speech, tongue stiffness, and right-sided limb weakness. Computed tomography angiography of the cerebral vessels revealed acute large-vessel occlusion. Therefore, the physician decided to perform prompt catheter-guided cerebral angioplasty. In this case study, the patient received comprehensive care addressing physical, psychological, emotional, social, and spiritual aspects. Nursing management included monitoring and management of neurogenic shock due to impaired cerebral blood flow and hypovolemic shock resulting from blood and fluid loss during a prolonged and complex surgical procedure. Nursing care included ventilator management and prevention of ventilator-associated complications. Bleeding related to anticoagulant therapy was closely monitored and prevented. Surgical wound care and pain management were provided. Fluid and electrolyte balance was maintained. Secondary complications were prevented. Physical and psychological rehabilitation was also implemented. In addition, education was provided to the patient and family, including discharge planning, to facilitate the patient’s return to normal daily life.

Keywords: Acute ischemic stroke, endovascular treatment, role of nursing.