Management of acute ischemic stroke – State of Art Review

BMJ 2020;368:l6983

Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide.

The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate
treatment, as fast as possible. This review is about pre-hospital and
emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset.

This also reviews protocols for the management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary
prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high-risk period immediately after stroke.

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