The evidence base supporting the management of patients with acute stroke is evolving at a rapid rate, as new methods that aim to reduce disability and death from stroke are explored. Intravenous tissue plasminogen activator remains the only treatment shown in numerous studies to reduce disability 3 months after stroke with no increase in the risk of death and a relatively minor rate of symptomatic intracerebral hemorrhage complications. Despite these findings, health care providers have been slow to adopt this evidence-based treatment, which results in many patients experiencing disability caused by stroke. Numerous controversies exist related to the management of patients with acute stroke, including the use of tissue plasminogen activator, positioning and early mobility, blood pressure lowering in acute intracerebral hemorrhage, and even the use of innovative advanced practice nurse–led stroke treatment teams, with varying amounts of evidence available to provide direction. This article explores controversies associated with both approved and evolving treatments for ischemic and hemorrhagic stroke and makes recommendations for practice on the basis of the body of existing evidence, with an aim to improve the delivery of acute stroke treatment.
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1 April 2012
Symposium the Challenge of Caring for Critically Ill Neuroscience Patients|
April 01 2012
Controversies in Acute Stroke Treatment
Mary K. Brethour, PhD, CRNP, ANVP;
Mary K. Brethour, PhD, CRNP, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Karin V. Nyström, MSN, APRN, ANVP;
Karin V. Nyström, MSN, APRN, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Sandra Broughton, MSN, APRN-BC, CNRN, ANVP;
Sandra Broughton, MSN, APRN-BC, CNRN, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Terri E. Kiernan, RN, MSN, ANP-BC, ANVP, CCRN, CNRN;
Terri E. Kiernan, RN, MSN, ANP-BC, ANVP, CCRN, CNRN
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Amy Perez, RN, MSN, CNRN, ANVP;
Amy Perez, RN, MSN, CNRN, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Diane Handler, RN, MSN, ANVP;
Diane Handler, RN, MSN, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Victoria Swatzell, RN, MSN, ANP-C, ANVP;
Victoria Swatzell, RN, MSN, ANP-C, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Joanna Jiehong Yang, RN, MS, RNFA, FNP-BC, ACNP-BC, ANVP;
Joanna Jiehong Yang, RN, MS, RNFA, FNP-BC, ACNP-BC, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Michele Starr, PA-C, ANVP;
Michele Starr, PA-C, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Karen B. Seagraves, RN, MSN, ANP-BC, ANVP;
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Karen B. Seagraves, RN, MSN, ANP-BC, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Fern Cudlip, RN, MSN, FNP-BC, ANVP;
Fern Cudlip, RN, MSN, FNP-BC, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Sharon Biby, RN, MSN, ANP-BC, GNP-BC, ANVP;
Sharon Biby, RN, MSN, ANP-BC, GNP-BC, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Susan Tocco, RN, MSN, CNRN, CCNS, ANVP;
Susan Tocco, RN, MSN, CNRN, CCNS, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Pauline Owens, RN, MSN, ANVP;
Pauline Owens, RN, MSN, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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Anne W. Alexandrov, RN, PhD, CCRN, ANVP
Anne W. Alexandrov, RN, PhD, CCRN, ANVP
Mary K. Brethour is Nurse Practitioner, Carle Hospital Stroke Team, Urbana, Illinois. Karin V. Nyström is Nurse Practitioner, Yale New Haven Hospital and Stroke Center, New Haven, Connecticut, and NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Sandra Broughton is Clinical Nurse Specialist, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona. Terri E. Kiernan is Nurse Practitioner and Assistant Professor of Neurology, Mayo Clinic-Phoenix, Department of Neurology, Phoenix, Arizona. Amy Perez is Stroke Coordinator, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Diane Handler is Stroke Coordinator, Mercy Medical Center Stroke Team, Cedar Rapids, Iowa. Victoria Swatzell is Nurse Practitioner, Scottsdale Healthcare-Osborn Stroke Team, Scottsdale, Arizona. Joanna Jiehong Yang is Nurse Practitioner, Loma Linda University Medical Center Stroke Team, Loma Linda, California. Michele Starr is Physician Assistant, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Integris Baptist Medical Center, James R. Daniel Cerebrovascular and Stroke Center, Oklahoma City, Oklahoma. Karen B. Seagraves is Stroke Program Manager, Grady Health System, Marcus Stroke and Neuroscience Center, Atlanta, Georgia. Fern Cudlip is Nurse Practitioner, Eden Medical Center Stroke Program, Castro Valley, California. Sharon Biby is Nurse Practitioner, Moses Cone Hospital Stroke Center, Greensboro, North Carolina. Susan Tocco is Clinical Nurse Specialist, Orlando Regional Medical Center Stroke Team, Orlando, Florida. Pauline Owens is Nurse Manager, NET SMART Advanced Practice Fellowship Program, Fountain Hills, Arizona, and Counties Manukau District Health Board, Middlemore Hospital Stroke Team, Auckland, New Zealand. Anne W. Alexandrov is Assistant Dean and Professor, DNP Program Coordinator, and Program Director, NET SMART, School of Nursing and Comprehensive Stroke Center, University of Alabama at Birmingham, Birmingham, AL 35294 (annealex@uab.edu).
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AACN Adv Crit Care (2012) 23 (2): 158–172.
Citation
Mary K. Brethour, Karin V. Nyström, Sandra Broughton, Terri E. Kiernan, Amy Perez, Diane Handler, Victoria Swatzell, Joanna Jiehong Yang, Michele Starr, Karen B. Seagraves, Fern Cudlip, Sharon Biby, Susan Tocco, Pauline Owens, Anne W. Alexandrov; Controversies in Acute Stroke Treatment. AACN Adv Crit Care 1 April 2012; 23 (2): 158–172. doi: https://doi.org/10.4037/NCI.0b013e31824fe1b6
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