Ischemic stroke

Обзор 
Теория 
Диагноз 
Лечение 
Последующее наблюдение 
Источники 

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Последний просмотренный: 26 Jun 2026

Last updated: 05 Jun 2026

Ischemic stroke is caused by a transient or permanent critical reduction in cerebral blood flow due to arterial stenosis or occlusion. It is a leading cause of morbidity and mortality worldwide.

Stroke is 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 most effective when given within 4.5 hours of stroke onset, and remains the standard of care. In patients with unknown time of onset or who present beyond 4.5 hours, imaging can be used to detect those with salvageable ischemic penumbra and who may benefit from intravenous thrombolysis.

Intravenous thrombolysis plus mechanical thrombectomy to treat large vessel occlusive (LVO) stroke within 6 hours of stroke onset is effective. Thrombectomy to treat LVO stroke is effective within 24 hours of onset if a penumbra is identified by multimodality imaging studies. Thrombectomy may improve functional outcome in LVO patients with a large core infarction or poor collateral circulation within 24 hours of onset.

Определение

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] See Transient ischemic attack.

Анамнез и осмотр

Ключевые диагностические факторы

vision loss or visual field deficit
weakness
aphasia
ataxia (impaired coordination)

Полная информация

Другие диагностические факторы

history of transient ischemic attack (TIA)
sudden onset of symptoms
negative symptoms (i.e., loss of function)
altered sensation
headache
diplopia
sensory loss
dysarthria
"crossed" syndromes
gaze paresis
arrhythmias, murmurs, or pulmonary edema
vertigo/dizziness
nausea and/or vomiting
neck or facial pain
miosis, ptosis, and facial anhidrosis (hemilateral)
altered level of consciousness/coma
confusion

Полная информация

Факторы риска

hypertension
older age
sickle cell disease
family history of stroke
history of transient ischemic attack (TIA)
history of ischemic stroke
cerebral microbleeds
smoking
diabetes mellitus
atrial fibrillation
comorbid cardiac conditions
carotid artery stenosis
intracranial atherosclerosis (ICAS)
dyslipidemia
lower levels of education
cancer
ethnicity
poor diet and nutrition
low birth weight
physical inactivity
obesity
alcohol misuse
use of oral estrogen-containing therapy
pregnancy
migraine
severe obstructive sleep apnea
long sleep duration and poor sleep quality
illicit drug use
hyperhomocysteinemia
elevated lipoprotein(a)
hypercoagulable states
elevated C-reactive protein
aortic arch plaques
patent foramen ovale (PFO)
air pollution
e-cigarettes
infections
endometriosis

Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

blood glucose
CT head
MRI brain
CT angiography or magnetic resonance angiography
CT or MRI perfusion
serum electrolytes
serum BUN and creatinine
cardiac enzymes
ECG
CBC
coagulopathy screen

Полная информация

Исследования, проведение которых нужно рассмотреть

serum toxicology screen
infection screen
genetic testing
CXR
carotid ultrasound
echocardiogram
transcranial Doppler ultrasound
conventional (invasive) angiography

Полная информация

Алгоритм лечения

Начальные

suspected acute ischemic stroke

Острый

acute ischemic stroke

Составители

Эксперты-консультанты

David Wang, DO, FAHA, FAAN

Professor of Neurology

Co-Director

Petznick Stroke Center

Neurovascular Division

Barrow Neurological Institute

Phoenix, AZ

Раскрытие информации

DW received honorarium from Boehringer Ingelheim for lectures on the use of thrombolytics for acute ischemic stroke. He has also received honorarium from Amgen, Zhongmei Huadong, and ShiYao Pharmaceuticals for speaking. DW was Chair, Stroke Section of the American Academy of Neurology, 2017-2019. He was Chair, Quality and Safety Subcommittee of the American Academy of Neurology (term ended June 2018). DW is an author of references cited in this topic.

Yi Dong, MD, PhD

Department of Neurology

Huashan Hospital

Fudan University

Shanghai

China

Раскрытие информации

YD declares that she has no competing interests.

Yilong Wang, MD, PhD

Professor of Neurology

Deputy Director, Department of Neurology

Beijing Tiantan Hospital, Capital Medical University

Beijing

China

Раскрытие информации

YW declares that he has no competing interests.

Выражение благодарностей

Dr David Wang, Dr Yi Dong, and Dr Yilong Wang would like to gratefully acknowledge Dr George Ntaios and Dr Alireza Minagar, the previous contributors to this topic.

Раскрытие информации

GN is on the advisory boards for, and has received honoraria, speaker fees, and research support from: Amgen, Bayer, Boehringer-Ingelheim, BMS/Pfizer, Elpen, Galenica, Medtronic, Sanofi, and Winmedica. AM declares that he has no competing interests.

Рецензенты

Nishant K. Mishra, MD, PhD, FRCP, FAHA

Assistant Professor of Neurology

Yale University

New Haven, CT

Раскрытие информации

NM declares that he has no competing interests.

Julien Morier, MD

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

Раскрытие информации

JM declares that he has no competing interests.

Louis R. Caplan, MD

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston, MA

Раскрытие информации

LRC declares that he has no competing interests.

Tony Rudd, MD

National Clinical Director

Stroke NHS England

Professor, Stroke Medicine

Kings College London

Chair, Intercollegiate Stroke Working Party

Royal College of Physicians

London

Раскрытие информации

TR declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-467.Полный текст Аннотация

Prabhakaran S, Gonzalez NR, Zachrison KS, et al. 2026 guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association/American Stroke Association. Stroke. 2026 Jan 26 [Epub ahead of print].Полный текст Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия
- Cerebral venous sinus thrombosis
- Intracerebral hemorrhage
- Transient ischemic attack (TIA)
Больше Отличия
Рекомендации
- 2026 guideline for the early management of patients with acute ischemic stroke
- Canadian stroke best practice recommendations: acute stroke management, 7th edition
Больше Рекомендации
Калькуляторы
ASCVD Risk Estimator
Atrial Fibrillation CHA(2)DS(2)-VASc Score for Stroke Risk
Больше Калькуляторы
Videos
Tracheal intubation: animated demonstration
Bag-valve-mask ventilation: animated demonstration
Больше Видео
Лифлеты для пациента
Stroke: treatment
Stroke: preventing another stroke
Больше Лифлеты для пациента
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Использование этого контента попадает под действие нашего заявления об отказе от ответственности

Ischemic stroke

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

Другие диагностические факторы

Факторы риска

Диагностические исследования

Исследования, которые показаны в первую очередь

Исследования, проведение которых нужно рассмотреть

Алгоритм лечения

suspected acute ischemic stroke

acute ischemic stroke

Составители

Эксперты-консультанты

David Wang, DO, FAHA, FAAN

Раскрытие информации

Yi Dong, MD, PhD

Раскрытие информации

Yilong Wang, MD, PhD

Раскрытие информации

Выражение благодарностей

Раскрытие информации

Рецензенты

Nishant K. Mishra, MD, PhD, FRCP, FAHA

Раскрытие информации

Julien Morier, MD

Раскрытие информации

Louis R. Caplan, MD

Раскрытие информации

Tony Rudd, MD

Раскрытие информации

Peer reviewer acknowledgements

Disclosures

Список литературы

Основные статьи

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Отличия

Рекомендации

Калькуляторы

Videos

Лифлеты для пациента

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись или оформите подписку, чтобы получить полноценный доступ к BMJ Best Practice

Войдите в учетную запись, чтобы получить полноценный доступ к BMJ Best Practice