Diagnosis and Management of Acute Ischemic Stroke

Mayo Clin Proc. 2018 Apr;93(4):523-538. doi: 10.1016/j.mayocp.2018.02.013.


Acute ischemic stroke (AIS) is among the leading causes of death and long-term disability. Intravenous tissue plasminogen activator has been the mainstay of acute therapy. Recently, several prospective randomized trials documented the value of endovascular revascularization in selected patients with large-vessel occlusion within the anterior circulation. This finding has led to a paradigm shift in the management of AIS, including wide adoption of noninvasive neuroimaging to assess vessel patency and tissue viability, with the supplemental and independent use of intravenous tissue plasminogen activator to improve clinical outcomes. In this article, we review the landmark studies on management of AIS and the current position on the diagnosis and management of AIS. The review also highlights the importance of early stabilization and prompt initiation of therapeutic interventions before, during, and after the diagnosis of AIS within and outside of the hospital.

Publication types

  • Review

MeSH terms

  • Administration, Intravenous
  • Brain Ischemia / diagnosis*
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / therapy*
  • Computed Tomography Angiography
  • Emergency Medical Services / methods
  • Endovascular Procedures / methods
  • Evidence-Based Medicine
  • Fibrinolytic Agents / therapeutic use
  • Humans
  • Magnetic Resonance Imaging
  • Neuroimaging
  • Perfusion Imaging
  • Randomized Controlled Trials as Topic
  • Stroke / diagnosis*
  • Stroke / diagnostic imaging
  • Stroke / therapy*
  • Stroke Rehabilitation / methods
  • Tenecteplase / therapeutic use
  • Thrombectomy / methods
  • Thrombolytic Therapy / methods
  • Time-to-Treatment
  • Tissue Plasminogen Activator / therapeutic use


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Tenecteplase