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Treatment of Acute Ischemic Stroke

Rabinstein, Alejandro A. MD, FAAN

doi: 10.1212/CON.0000000000000420
Review Articles

ABSTRACT: Purpose of Review: This article provides an update on the state of the art of the emergency treatment of acute ischemic stroke with particular emphasis on the alternatives for reperfusion therapy.

Recent Findings: The results of several randomized controlled trials consistently and conclusively demonstrating that previously functional patients with disabling strokes from a proximal intracranial artery occlusion benefit from prompt recanalization with mechanical thrombectomy using a retrievable stent have changed the landscape of acute stroke therapy. Mechanical thrombectomy within 6 hours of symptom onset should now be considered the preferred treatment for these patients along with IV thrombolysis with recombinant tissue plasminogen activator (rtPA) within the first 4.5 hours for all patients who do not have contraindications for systemic thrombolysis. Patients who are ineligible for IV rtPA can also benefit from mechanical thrombectomy. Collateral status and time to reperfusion are the main determinants of outcome.

Summary: Timely successful reperfusion is the most effective treatment for patients with acute ischemic stroke. Systems of care should be optimized to maximize the number of patients with acute ischemic stroke able to receive reperfusion therapy.

Address correspondence to Dr Alejandro Rabinstein, Mayo Clinic, Department of Neurology, W8B, 200 First St SW, Rochester, MN 55905, rabinstein.alejandro@mayo.edu.

Relationship Disclosure: Dr Rabinstein serves as an associate editor for Neurocritical Care; on the editorial boards of Continuum: Lifelong Learning in Neurology, the Journal of Stroke and Cerebrovascular Diseases, Neurology, and Stroke; and on the scientific advisory board of Portola Pharmaceuticals, Inc. Dr Rabinstein receives research/grant support from DJO Global, Inc, and royalties from Elsevier, Oxford University Press, and UpToDate, Inc.

Unlabeled Use of Products/Investigational Use Disclosure: Dr Rabinstein reports no disclosure.

© 2017 American Academy of Neurology