Advancements in the management of acute ischemic stroke: A narrative review

Primary literature detailing updated management principles of acute ischemic stroke outpaces current guidelines, resulting in heterogenous practices. Recent advancements in neuroimaging have shifted treatment from a time‐based approach to an individualized, image‐guided appraisal directed by the pre...

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Published inJournal of the American College of Emergency Physicians Open Vol. 4; no. 1; pp. e12896 - n/a
Main Authors Robbins, Blake T., Howington, Gavin T., Swafford, Kara, Zummer, Jaryd, Woolum, Jordan A.
Format Journal Article
LanguageEnglish
Published United States John Wiley & Sons, Inc 01.02.2023
John Wiley and Sons Inc
Wiley
Subjects
acute ischemic stroke
fibrinolytics
Hemorrhage
Ischemia
Magnetic resonance imaging
Medical imaging
Mortality
Neuroimaging
Neurology
Patients
Review
Stroke
tenecteplase
thrombectomy
fibrinolytics
acute ischemic stroke
thrombectomy
tenecteplase
neuroimaging
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Summary:Primary literature detailing updated management principles of acute ischemic stroke outpaces current guidelines, resulting in heterogenous practices. Recent advancements in neuroimaging have shifted treatment from a time‐based approach to an individualized, image‐guided appraisal directed by the presence or absence of salvageable brain tissue. In addition, tenecteplase appears to be a safe and effective for the treatment of acute ischemic stroke and is becoming an attractive agent due to its practical administration. Several factors must be accounted for when implementing tenecteplase into the health‐system including cost, education, and changes in clinician workflows. Larger studies with broad patient populations are needed to more definitively evaluate whether intravenous thrombolytics should be used in combination with endovascular thrombectomy in patients with anterior large‐vessel occlusions. Although debate regarding the safety and efficacy of various endovascular therapies, delays encountered in the identification, triage, and care of acute ischemic stroke patients increase the likelihood of necrotic core lesion development and loss of salvageable penumbra.
Bibliography:The authors have stated that no such relationships exist.
Funding and support: By
Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see
www.icmje.org
Supervising Editor: Prasanthi Govindarajan, MBBS, MAS.
JACEP
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SourceType-Scholarly Journals-1
ObjectType-Feature-2
ObjectType-Review-3
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Funding and support: By JACEP Open policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist.
ISSN:2688-1152
2688-1152
DOI:10.1002/emp2.12896