Patients appropriate for INCU include:

• Baseline infarct core size <70 mL
• ASPECTS >=6
• TICI score 2B, 2C, or 3
• Minimal hemorrhage or contrast staining on post-procedure DynaCT (at the discretion of the stroke fellow)
• MAC only
• No groin complications (d/c arterial sheath, achieve hemostasis)
• Hemodynamically stable (VS fall within prescribed parameters)
• No use of Balloon Angioplasty or Rescue Stenting
• No basilar occlusions

Patients should:

• Go to NICU if any of the above criteria are not met or there is a change in patient condition  

Sedation Recovery:

• Patients who were administered minimal to moderate sedation, and have returned to their pre-procedure baseline would be suitable candidates for INCU. 
• Recovered from sedation = back to pre-procedural baseline
• If deeper plan of sedation, consider NICU
• If by end of the case/groin closure time, patient is not back to baseline patient to go to NICU.
  • Anesthesia and NIR team to make this decision and communicate to Stroke Consult Fellow
  • Stroke Consult Fellow to update disposition EPIC order and secure chat

Coordination & Communication = Acute Stroke Team (HUP) Secure Chat

• Based off inclusion criteria above, pre-procedure STROKE CONSULT FELLOW to comment in chat DIRECT TO INCU possible
• Bed management and INCU charge to confirm bed availability and identify quickest bed
• Clinical Lead (or other ICU resource RN) to take report and still respond, this process does not change
• Post procedure STROKE IR FELLOW and ANESTHESIA to confirm patient at pre-procedural baseline and safe for DIRECT to INCU
• If a change in disposition (NICU), need to adjust order and notify bed management ASAP
  • Stroke Consult Fellow to place order
• 3 way handoff to include: Stroke consult Fellow, NIR fellow, senior resident on stroke, INCU RN, Clinical Lead
• Stroke Consult Fellow to write .NCCstroke note
• MT patient to have priority INCU bed over ICU downgrade if this scenario occurs