Modern medical management of acute ischemic stroke

Methodist Debakey Cardiovasc J. 2014 Apr-Jun;10(2):99-104. doi: 10.14797/mdcj-10-2-99.

Abstract

The modern management of patients with ischemic stroke begins by having a system in place that organizes the provision of preventive, acute treatment, and rehabilitative services. In the acute setting, initial evaluation is aimed at rapidly establishing a diagnosis by excluding stroke mimics, distinguishing between ischemic and hemorrhagic strokes, and determining if the patient is a candidate for treatment with intravenous tissue plasminogen activator (IV-tPA, alteplase). In some centers, select patients who do not qualify for administration of IV-tPA may be considered for endovascular intervention. General measures include the use of platelet antiaggregants, treatment of fever, blood pressure management, and continuation of statins if the patient has already been taking them. Post-acute evaluation and management is aimed at secondary prevention and optimizing recovery, including recognition and treatment of post-stroke depression.

Keywords: blood pressure; complications; depression; fever; ischemic stroke; platelet antiaggregants; reperfusion.

Publication types

  • Review

MeSH terms

  • Brain Ischemia / diagnosis
  • Brain Ischemia / mortality
  • Brain Ischemia / physiopathology
  • Brain Ischemia / therapy*
  • Critical Pathways
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / methods
  • Endovascular Procedures* / mortality
  • Fibrinolytic Agents / administration & dosage*
  • Fibrinolytic Agents / adverse effects
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Infusions, Intravenous
  • Platelet Aggregation Inhibitors / therapeutic use
  • Risk Factors
  • Stroke / diagnosis
  • Stroke / mortality
  • Stroke / physiopathology
  • Stroke / therapy*
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / methods
  • Thrombolytic Therapy* / mortality
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors

Grants and funding

Funding/Support: The author has received honoraria as a speaker at a Pfizer educational meeting.