Although stroke declined from the third to fifth most common cause of death in the United States, the annual incidence and overall prevalence continue to increase. Since the available US Food and Drug Administration–approved treatment options are time dependent, improving early stroke care may have more of a public health impact than any other phase of care. Timely and efficient stroke treatment should be a priority for emergency department and prehospital providers. This article discusses currently available and emerging treatment options in acute ischemic stroke focusing on the preservation of salvageable brain tissue, minimizing complications, and secondary prevention.
Key points
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The treatment of acute ischemic stroke is aimed at reperfusing ischemic tissue, halting progression of infarction, and preventing recurrence.
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Brain parenchyma is sensitive to brief periods of oligemia and hypoperfusion, and the success of reperfusion therapies are highly time dependent.
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Intravenous thrombolysis may benefit patients experiencing an acute ischemic stroke up to 4.5 hours from symptom onset.
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Emergency medicine systems of care should focus on the availability and speed of access to reperfusion therapies to maximize the benefit for as many patients as possible.
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Extended time window reperfusion, neuroprotection, and adjunctive therapies remain exciting areas of acute ischemic stroke research.
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