Review article

Management of acute ischemic stroke. The faster, the better

SABINE HÖRER ; Department of Neurology and Neurological Intensive Medicine, Klinikum Harlaching, Städtisches Klinikum Muenchen GmbH, Munich, Germany
ROMAN HABERL ; Department of Neurology and Neurologic Intensive Medicine, Klinikum Harlaching, Staedtisches Klinikum, München GmbH, Sanatoriumsplatz 2, D-81545 München, Germany

Abstract

Ischemic stroke is an emergency. Immediate ambulance transportation, cautious lowering of excessive blood pressures >220/120mmHg and abstention from heparin and aspirin are the most important measures in the preclinical setting.Hospital prenotification and clearly structured in-hospital pathways can help to reduce delay to treatment. Stroke patients are best treated in dedicated stroke units where vital parameters are monitored and
stroke-related complications are recognized. Blood glucose should be in a normal range. Intravenous thrombolysis in the 3 hours window is the only approved efficacious, but time-dependent reperfusion therapy of acute ischemic stroke.Treatmentwith alteplase>3 to 4.5 hours fromsymptomonset and in elderly patients>80 years is beneficial and recommended by the European Stroke Organisation, but off-label. In severe stroke with CT-angiographical occlusion of a large intracranial artery, mechanical recanalisation is increasingly
used. Only a small proportion of otherwise eligible stroke patients
receive reperfusion therapy, mostly due to prehospital delay. The following article highlights on emergencymanagement of acute ischemic stroke, and on strategies howthe number of patientswho benefit fromacute stroke treatment and thrombolytic therapy may be increased.

Keywords

Hrčak ID:

96133

URI

https://hrcak.srce.hr/96133

Publication date:

30.9.2012.

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