Evaluation and management of acute ischemic stroke.

PURPOSE OF REVIEW

This review provides an overview of emergent evaluation of the stroke patient with an emphasis on practical issues regarding ischemic stroke treatment.

RECENT FINDINGS

The IV recombinant tissue-type plasminogen activator (rtPA) treatment window has been expanded from 3 to 4.5 hours from symptom onset. The evidence for better outcomes with more rapid initiation of reperfusion therapies is very strong. Adjunctive endovascular therapy has not been shown to benefit all patients with moderate or severe strokes, and investigations are underway to identify subgroups that may benefit from this approach. Endovascular therapy should be considered for patients who are ineligible for IV rtPA and can begin treatment within 6 hours of stroke onset.

SUMMARY

Effective emergent evaluation of a stroke patient requires well-organized systems that maximize speed of assessment and administration of appropriate therapies, including IV rtPA and endovascular therapies.