Ischemic stroke

Ischemic stroke is a leading cause of morbidity and mortality.

Approximately 85% of strokes are ischemic, caused by arterial occlusion.

A clinical emergency: timely diagnosis, triage, and intervention improves outcomes.

Care of patients in dedicated stroke units improves survival and function.

Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) is effective when given within 4.5 hours of stroke onset, and remains the standard of care. Intravenous alteplase may be beneficial when given between 4.5 and 9.0 hours after stroke onset in patients shown by perfusion imaging to have salvageable brain tissue. Tenecteplase may be beneficial in treating acute ischemic stroke within 4.5 hours of onset.

Mechanical thrombectomy within 6 hours of stroke onset (with intravenous thrombolysis) is effective for treating ischemic stroke caused by large vessel occlusion. Thrombectomy may also be considered (without intravenous thrombolysis) for carefully selected patients.

Stroke is defined as an acute neurologic deficit caused by cerebrovascular abnormality. It is further subdivided into ischemic stroke (caused by arterial occlusion or stenosis) and hemorrhagic stroke (caused by vascular rupture, resulting in intraparenchymal and/or subarachnoid hemorrhage).

This topic deals with ischemic stroke.

Transient ischemic attack (TIA) is defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia, without acute infarction. Patients with TIAs are at high risk for early ischemic stroke.[1]Amarenco P, Lavallée PC, Labreuche J, et al. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med. 2016 Apr 21;374(16):1533-42. https://www.nejm.org/doi/full/10.1056/NEJMoa1412981 http://www.ncbi.nlm.nih.gov/pubmed/27096581?tool=bestpractice.com