Hyperacute Management of Ischemic Strokes: JACC Focus Seminar

J Am Coll Cardiol. 2020 Apr 21;75(15):1844-1856. doi: 10.1016/j.jacc.2020.03.006.

Abstract

Acute ischemic stroke is the leading cause of disability and among the leading causes of mortality worldwide. Intravenous tissue plasminogen activator has been a cornerstone for treatment of acute ischemic stroke for more than 20 years; however, its use is limited due to a narrow therapeutic window, several contraindications, and low efficacy to recanalize the artery in large vessel occlusion. Recently, the addition of endovascular mechanical thrombectomy of large artery occlusion has revolutionized the stroke treatment for most disabling strokes. The paper reviews updates to the thrombolytic treatment as well as catheter-based treatment, and results from recent trials in the selection of patients in an extended time window using perfusion imaging.

Keywords: IV-rtPA; acute ischemic stroke; imaging in acute stroke; mechanical thrombectomy; mechanical thrombectomy in extended time window.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Anesthesia, General
  • Arterial Occlusive Diseases / complications
  • Arterial Occlusive Diseases / therapy
  • Clinical Trials as Topic
  • Conscious Sedation
  • Contraindications, Drug
  • Fibrinolytic Agents / therapeutic use*
  • Hemodynamics
  • Humans
  • Intracranial Arteriosclerosis / complications
  • Intracranial Arteriosclerosis / therapy
  • Ischemic Stroke / etiology
  • Ischemic Stroke / therapy*
  • Neuroimaging
  • Practice Guidelines as Topic
  • Thrombectomy*
  • Time-to-Treatment
  • Tissue Plasminogen Activator / therapeutic use
  • Triage

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator