Acute Ischemic Stroke

Acute Ischemic Stroke Treatment for patients with acute ischemic stroke is guided by the time from the onset of stroke, the severity of neurologic deficit, and findings on neuroimaging. By convention, the time of stroke onset is established as the time that the patient was last known to be well (i.e., in a normal or baseline state, as confirmed by medical history). Intravenous thrombolysis with alteplase (a recombinant tissue plasminogen activator) improves outcomes in selected patients with acute ischemic stroke when administered within 4.5 hours after onset. Later treatment may improve outcomes in selected patients, with the treatment window extended to 9 hours from onset. Intraarterial catheter-based mechanical thrombectomy of occluded large intracranial arteries improves outcomes in selected patients with acute ischemic stroke when performed up to 24 hours after onset. The benefit of alteplase and mechanical thrombectomy is time-dependent, so assessment and treatment should be instituted rapidly. In selected patients with mild acute ischemic stroke who do not qualify for intravenous thrombolysis or mechanical thrombectomy, dual antiplatelet therapy with clopidogrel and aspirin when administered within 24 hours after onset and continuedfor 21 days lowers the risk of recurrent stroke. Treatment for patients with acute ischemic stroke is guided by the time from the onset of stroke, the severity of neurologic deficit, and findings on neuroimaging. Recommended treatments in selected patients include intravenous thrombolysis with alteplase and mechanical thrombectomy.