Acute ischemic stroke
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Advances in the Management of Acute Ischemic Stroke
Introduction to Acute Ischemic Stroke
Acute ischemic stroke (AIS) is a leading cause of death and long-term disability worldwide. It occurs when a blood clot obstructs an artery supplying blood to the brain, leading to focal cerebral ischemia. Approximately 80% of strokes are ischemic in nature, with the incidence highly age-dependent. Early recognition and prompt treatment are critical to improving outcomes and reducing mortality and morbidity associated with AIS .
Early Recognition and Emergency Treatment
The cornerstone of effective AIS management is the rapid identification of stroke symptoms and swift transport to specialized stroke centers. Emergency medical services (EMS) protocols play a crucial role in the pre-hospital identification and triage of stroke patients. Early administration of intravenous thrombolysis with tissue plasminogen activator (tPA) within 4.5 hours of symptom onset is a well-established treatment that significantly improves outcomes . Recent updates have extended the time window for tPA administration, enabling more patients to benefit from this therapy.
Advanced Imaging and Endovascular Therapy
Advanced imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), are essential for assessing vessel patency and identifying patients who may benefit from endovascular thrombectomy. This procedure is particularly beneficial for patients with large-vessel occlusions within the anterior circulation and can be performed within 6 hours of stroke onset . Automated imaging interpretation helps identify patients with salvageable brain tissue, guiding treatment decisions.
Physiological Management and Secondary Prevention
Managing physiological parameters, such as blood glucose levels, is vital in minimizing infarct volumes and improving outcomes. Hyperglycemia at the time of stroke onset is associated with worse outcomes, particularly in non-lacunar strokes. Additionally, early administration of aspirin and close monitoring for neurological and medical complications are recommended in the initial days following a stroke.
Secondary prevention strategies, including short-term dual antiplatelet therapy, are crucial in preventing recurrent strokes during the high-risk period immediately after the initial event. Comprehensive stroke rehabilitation programs are essential for optimizing post-stroke recovery and improving long-term outcomes.
Emerging Therapies and Future Research
Research into novel therapies and diagnostic markers continues to evolve. Circulating microRNAs (miRNAs) have shown potential as diagnostic biomarkers for AIS, although further studies are needed to validate their clinical utility. Additionally, neuroprotective therapies, such as the use of magnesium, statins, and induced hypothermia, are being explored to enhance treatment outcomes.
Conclusion
The management of acute ischemic stroke has seen significant advancements in recent years, with early recognition, timely intervention, and comprehensive care being pivotal in improving patient outcomes. Continued research and the development of new therapies hold promise for further reducing the burden of this debilitating condition.
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