Cutting Edge Acute Ischemic Stroke Management

Emerg Med Clin North Am. 2019 Aug;37(3):365-379. doi: 10.1016/j.emc.2019.03.001. Epub 2019 May 21.

Abstract

Acute ischemic stroke (AIS) is a medical emergency that requires prompt recognition and streamlined work-up to ensure that time-dependent therapies are initiated to achieve the best outcomes. This article discusses frequently missed AIS in the emergency department, the role of various imagining modalities in the work-up of AIS, updates on the use of intravenous thrombolytics and endovascular therapy for AIS, pearls on supportive care management of AIS, and prehospital and hospital process improvements to shorten door-to-needle time.

Keywords: Acute ischemic stroke; Endovascular mechanical thrombectomy; Process improvement; Stroke imaging; Stroke management; Stroke window; System improvement.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Blood Glucose / analysis
  • Brain / diagnostic imaging
  • Brain Ischemia / diagnostic imaging*
  • Brain Ischemia / therapy*
  • Clinical Decision-Making
  • Clinical Trials as Topic
  • Emergency Medicine
  • Endovascular Procedures
  • Fever / prevention & control
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Hypertension / therapy
  • Oxygen Inhalation Therapy
  • Patient Transfer
  • Stroke / diagnosis*
  • Stroke / therapy*
  • Telemedicine
  • Tenecteplase / therapeutic use
  • Thrombectomy
  • Thrombolytic Therapy
  • Time-to-Treatment
  • Tissue Plasminogen Activator / therapeutic use

Substances

  • Blood Glucose
  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Tenecteplase