UPDATE IN THE MANAGEMENT OF ACUTE ISCHEMIC STROKE
Keywords:
acute ischemic stroke, management, guidelines, intravenous thrombolysis, mechanical thrombectomyAbstract
Acute ischemic stroke (AIS) occurs due to a sudden thrombotic or embolic occlusion of a cerebral artery, which results in impaired neurologic function. The data from the World Health Organization (WHO) show that 15 million people suffer a stroke worldwide each year. Of these, 5 million have lethal outcome, and another 5 million have permanent disability. Stroke is the second most common single cause of mortality in Europe. According to the system of stroke classification developed in the multicenter Trial of ORG 10172 in Acute Stroke Treatment (TOAST), ischemic stroke is divided into the following 3 major subtypes: large-artery, small-vessel, or lacunar and cardioembolic infarction. Diagnosis of AIS is established based on a neurological examination, computer tomography (CT), scans or magnetic resonance imaging (MRI) scans, Doppler ultrasound, and CT/MR angiography. The main pillars of AIS treatment are stroke unit (SU) care and treatments promoting revascularization. Since 2002, intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rtPA) has been approved in Europe for use in acute stroke treatment. In the beginning of 2021, the European Stroke Organization (ESO) published new guidelines on intravenous thrombolysis for AIS. There are 40 new recommendations and the most important ones focus on early and late time windows, stroke of unknown onset, advanced imaging, use of alteplase and tenecteplase, minor and severe strokes, intravenous thrombolysis in patients over 80 years of age or with previous disability or frailty and potential risk factors for bleeding including use of oral anticoagulants.
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