Ischemic stroke is the first, second, and third most common cause of disability, dementia, and death, respectively. The introduction of intravenous thrombolytic treatment (IVT) and endovascular treatment (EVT) led to substantial functional prognosis improvements in patients. These treatments have radically modified the initial management of stroke. Even though the faster the better, later IVT may improve outcomes in selected patients by extending the treatment window to 9 hours after onset. These patients are selected by means of brain perfusion imaging. According to perfusion parameters, patients can be eligible for EVT until 24 hours after symptoms onset. At the same time, indications for IVT have been expanded and contraindications reduced. More patients can see their prognosis improved.
What is already known about the topic?
Ischemic stroke affects more than 50 Belgians every day and is caused by a brain artery occlusion. Disability, at different levels, is the most feared consequence after a brain attack. In selected cases, recanalization of the occluded artery as quickly as possible led to improved outcomes. Because a lack of oxygen (hypoxia) is harmful to the brain, the treatment must be administered as soon as possible.
What does this article bring up for us?
This article summarizes the current therapeutic guidelines for acute ischemic stroke (in particular, late window IVT and EVT), through measurement of brain penumbra thanks to perfusion imaging protocols) and describes the best practice in secondary stroke prevention. This article could be useful for emergency physicians, but also for general practitioners in their clinical practice.
Keywords
Ischemic stroke, thrombolysis, perfusion imaging, treatments