Abstract
Ischemic stroke is a medical emergency associated with significant morbidity and mortality. Over the past 25 years, the treatment of acute ischemic stroke has dramatically evolved. Currently, ischemic brain reperfusion is possible with pharmacologic, endovascular, and combined treatments. More recently, the use of advanced imaging allows identifying patients with salvageable ischemic brain tissue beyond the classic time-based window (tissue-based window) who benefit from reperfusion treatments. Stroke patients also benefit from monitoring in dedicated stroke units. This specialized environment is ideal for the detection and treatment of neurological deterioration and potential complications, and the timely institution of secondary prevention treatments and rehabilitation. This chapter aims to provide an updated and practical evidence-based guidance to the initial evaluation and treatment of acute stroke patients.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kaufmann AM, Firlik AD, Fukui MB, Wechsler LR, Jungries CA, Yonas H. Ischemic core and penumbra in human stroke. Stroke. 1999;30:93–9.
Bang OY, Goyal M, Liebeskind DS. Collateral circulation in ischemic stroke. Stroke [online serial]; 2015;46:3302–3309.
Rabinstein AA. Treatment of acute ischemic stroke. Continuum (Minneap Minn). 2017;23:62–81.
Anderson CS, Arima H, Lavados P, et al. Cluster-randomized, crossover trial of head positioning in acute stroke. N Engl J Med [online serial]. 2017;376:2437–47.
Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke [online serial]. 2018;49:e46–110. Accessed at: http://www.ncbi.nlm.nih.gov/pubmed/29367334.
Johnston KC, Bruno A, Pauls Q, et al Intensive vs Standard Treatment of Hyperglycemia and Functional Outcome in Patients With Acute Ischemic Stroke The SHINE RandomizedClinical TrialJAMA. 2019;322(4):326–335.
den Hertog HM, van der Worp HB, van Gemert HMA, et al. The Paracetamol (Acetaminophen) In Stroke (PAIS) trial: a multicentre, randomised, placebo-controlled, phase III trial. Lancet Neurol. 2009;8:434–40.
Fonarow GC, Smith EE, Saver JL, et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s target: stroke initiative. Stroke. 2011;42:2983–9.
Barber PA, Demchuk AM, Zhang J, Buchan AM. Validity and reliability of a quantitative computed tomography score in predicting outcome of hyperacute stroke before thrombolytic therapy. ASPECTS Study Group. Alberta Stroke Programme Early CT Score. Lancet [online serial]. 2000;355:1670–4. Accessed at: http://www.ncbi.nlm.nih.gov/pubmed/10905241.
The National Institute Of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med [online serial]. 2008;359:1317–1329. Accessed at: http://www.ncbi.nlm.nih.gov/pubmed/18815396. Accessed 4 April 2016.
Lansberg MG, Schrooten M, Bluhmki E, Thijs VN, Saver JL. Treatment time-specific number needed to treat estimates for tissue plasminogen activator therapy in acute stroke based on shifts over the entire range of the modified Rankin Scale. Stroke. 2009;40:2079–84.
Khatri P, Conaway MR, Johnston KC. Ninety-day outcome rates of a prospective cohort of consecutive patients with mild ischemic stroke. Stroke. 2012;43:560–2.
Khatri P, Kleindorfer DO, Devlin T, et al. Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: the PRISMS randomized clinical trial. JAMA. 2018;320:156–66.
Anderson CS, Robinson T, Lindley RI, et al. Low-dose versus standard-dose intravenous alteplase in acute ischemic stroke. N Engl J Med. 2016;374:2313–23.
Logallo N, Novotny V, Assmus J, et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol. 2017;16:781–8.
Seet RCS, Rabinstein AA. Symptomatic intracranial hemorrhage following intravenous thrombolysis for acute ischemic stroke: a critical review of case definitions. Cerebrovasc Dis [online serial]. 2012;34:106–114. Accessed at: https://www.karger.com/Article/FullText/339675.
Goyal M, Menon BK, van Zwam WH, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387:1723–31.
Campbell BCV, Mitchell PJ, Churilov L, et al. Tenecteplase versus alteplase before thrombectomy for ischemic stroke. N Engl J Med [online serial]. 2018;378:1573–82.
Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med [online serial]. Massachusetts Medical Society; 2017;378:11–21.
Albers GW, Marks MP, Kemp S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med [online serial]. Massachusetts Medical Society; 2018;378:708–18.
Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med [online serial]. Massachusetts Medical Society; 2018;379:611–22.
Ma H, Campbell BCV, Parsons MW, et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke. N Engl J Med. 2019;380:1795–803.
Campbell BCV, Ma H, Ringleb PA, et al. Extending thrombolysis to 4.5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data. Lancet. 2019;394(10193):139–47.
Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev. 2013;(9):CD000197.
Easton JD, Saver JL, Albers GW, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardio. Stroke [online serial]. 2009;40:2276–93.
Lavallee PC, Meseguer E, Abboud H, et al. A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol. 2007;6:953–60.
Johnston SC, Easton JD, Farrant M, et al. Clopidogrel and aspirin in acute ischemic stroke and high-risk TIA. N Engl J Med [online serial]. Massachusetts Medical Society; 2018;379:215–25.
Adams HP, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke [online serial]. 1993;24:35–41. Accessed at: http://www.ncbi.nlm.nih.gov/pubmed/7678184. Accessed 10 June 2016.
Chimowitz MI, Lynn MJ, Derdeyn CP, et al. Stenting versus aggressive medical therapy for intracranial arterial stenosis. N Engl J Med. 2011;365:993–1003.
Thaler DE, Ruthazer R, Weimar C, et al. Recurrent stroke predictors differ in medically treated patients with pathogenic vs. other PFOs. Neurology. 2014;83:221–6.
Søndergaard L, Kasner SE, Rhodes JF, et al. Patent foramen ovale closure or antiplatelet therapy for cryptogenic stroke. N Engl J Med [online serial]. Massachusetts Medical Society; 2017;377:1033–42.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Hawkes, M.A., Rabinstein, A.A. (2020). Acute Ischemic Stroke. In: Rabinstein, A. (eds) Neurological Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-030-28072-7_9
Download citation
DOI: https://doi.org/10.1007/978-3-030-28072-7_9
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-28071-0
Online ISBN: 978-3-030-28072-7
eBook Packages: MedicineMedicine (R0)