This review provides an overview of emergent evaluation of the stroke patient with an emphasis on practical issues regarding ischemic stroke treatment.
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.
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.
Address correspondence to Dr Pooja Khatri, Department of Neurology, University of Cincinnati, 260 Stetson Street, ML 0525, Cincinnati, OH 45267-0525, firstname.lastname@example.org.
Relationship Disclosure: Dr Khatri has received research grants from the NIH and research support from Penumbra Inc and Genentech, Inc.
Unlabeled Use of Products/Investigational Use Disclosure: Dr Khatri discusses the use of IV tissue plasminogen activator for minor stroke and of endovascular therapy for stroke treatment, neither of which are approved by the US Food and Drug Administration.