Surgical Interventions for Stroke

What is the purpose of a carotid endarterectomy?

When is thrombolytic therapy with alteplase most effective?

What condition indicates the need for carotid angioplasty with stenting?

What should be monitored carefully when administering thrombolytics?

In which situation should alteplase not be administered?

What is the main goal of bypass surgery in patients with TIAs?

What does the procedure of carotid endarterectomy involve?

Which of the following describes a situation suitable for an extracranial-intracranial bypass?

What is the primary purpose of administering tPA in stroke therapy?

What is the recommended time frame for administering tPA to increase recovery chances?

What is a critical nursing assessment after administering tPA?

Which laboratory value should be checked prior to administering tPA?

What complication is most commonly associated with tPA therapy?

Which therapy focuses primarily on helping patients regain motor skills for daily activities?

Why should patients avoid anticoagulants or antiplatelet agents after receiving tPA?

What enzyme does tPA convert from plasminogen to aid in dissolving blood clots?

What dietary items should be avoided by patients after receiving tPA due to influencing clotting mechanism?

What role does tPA play in the circulatory system after a stroke?

Carotid Endarterectomy - A surgical procedure to remove atherosclerotic plaque from the carotid artery bifurcation.
- Performed in patients who have had transient ischemic attacks (TIAs) or are at risk of stroke.
- Involves clamping the carotid artery, making an incision, removing plaque, and suturing/grafting to restore blood flow.
Extracranial-intracranial Bypass - A surgical procedure for occluded or stenotic vessels not amenable to arterial clearance using radiologic visualization.
- May be performed on the internal carotid, middle cerebral, or vertebral arteries.
- Used for patients experiencing ischemia due to TIAs or mild strokes.
- Reconnects blood flow to the affected brain area.
Carotid Angioplasty with Stenting - A minimally invasive procedure used to widen narrowed carotid arteries.
- Used for cerebral stenosis.

Tissue Plasminogen Activator (tPA) - A drug that dissolves blood clots. Alteplase (Activase) is the only tPA indicated for stroke.
- Mechanism of Action: Binds to fibrin in blood clots, converting plasminogen to plasmin, which destroys fibrin.
- Administration: Must be administered within 12 hours of symptom onset, ideally within 3 hours for optimal results.
- Nursing Considerations: Monitor for bleeding rigorously, as tPA dissolves all clots.
- Contraindications: Do not administer to patients with recent trauma, falls, or motor vehicle accidents.

Physical Therapy: Helps prevent contractures and improves muscle strength and coordination.
- Focuses on regaining mobility skills like walking, sitting, lying down, and transitioning between movements.
Occupational Therapy: Provides assistive devices and strategies for regaining lost motor skills.
- Addresses activities of daily living, such as eating, drinking, bathing, cooking, reading, writing, and toileting.
Speech and Language Therapy: Helps patients relearn language and communication skills, and address swallowing difficulties.