Management of acute ischemic stroke

Abstract

Acute stroke affects about 800,000 patients annually in the US and is the leading cause of disability. It is a complex condition with multiple causes and requires comprehensive but rapid evaluation by stroke specialists working in institutions with well-organized stroke systems of care. Acute stroke treatment is focused on early revascularization with intravenous tPA for those with strokes under 3 hours duration or intra-arterial therapy for most others and those who cannot receive tPA. The latter is evolving rapidly with the advent of stent-retriever embolectomy devices that are poised to revolutionize stroke treatment. Recanalization is associated with neurological recovery in 33-50 % of patients. This also means that many patients may have devastating and life-threatening brain injury, which highlights the need for comprehensive care for the prevention and treatment of medical complications, management of cerebral edema and intracerebral hemorrhage.