From the Guidelines
I strongly recommend immediate medical attention for Adam, as stroke is a life-threatening emergency where timely treatment is crucial to minimize brain damage and improve recovery outcomes. According to the most recent guidelines 1, the standard acute treatment for ischemic stroke (if diagnosed within 4.5 hours of symptom onset) is intravenous tissue plasminogen activator (tPA), followed by possible mechanical thrombectomy for large vessel occlusions.
Key Recommendations
- Call emergency services right away and have Adam lie down with his head slightly elevated
- Note the time symptoms began, and don't give him food, drink, or medication while waiting for help
- Intravenous tPA (0.9 mg/kg, maximum dose 90 mg over 60 min) is recommended for selected patients who can be treated within 4.5 h of ischemic stroke symptom onset or last known well 1
- Patients with AIS and acute hypertension who are otherwise eligible for IV thrombolysis should have their BP lowered below 185/110 mm Hg before IV thrombolysis is initiated 1
- Eligible patients should receive IV thrombolysis even if mechanical thrombectomy is being considered 1
Post-Stabilization Care
After stabilization, secondary prevention typically includes:
- Antiplatelet therapy (aspirin 81-325mg daily or clopidogrel 75mg daily)
- Statins
- Blood pressure management
- Lifestyle modifications It is essential to follow the guidelines outlined in the International Journal of Stroke 1 to ensure the best possible outcomes for Adam. The American Stroke Association guidelines 1 also emphasize the importance of urgent evaluation and treatment, including measures to protect the airway, breathing, and circulation, as well as the use of intravenous rtPA for carefully selected patients. However, the most recent guidelines 1 take precedence in guiding treatment decisions.
From the Research
Stroke Overview
- Stroke is a leading cause of morbidity and mortality and a major cause of long-term disability 2
- It is a clinically defined syndrome of acute, focal neurological deficit attributed to vascular injury (infarction, haemorrhage) of the central nervous system 3
- The most important modifiable risk factor for stroke is hypertension, although its contribution differs for different subtypes 3
Treatment Options
- Systemic thrombolysis with alteplase is the only approved medical treatment for patients with acute ischaemic stroke 4, 5
- Thrombectomy is also increasingly used to treat proximal occlusions of the cerebral arteries, but has not shown superiority over systemic thrombolysis with alteplase 4
- Tenecteplase has emerged as a potential alternative thrombolytic agent that might be preferred over alteplase because of its ease of administration and reported efficacy in patients with large vessel occlusion 5
Safety and Efficacy
- Pretreatment with aspirin monotherapy increases the bleeding risk of alteplase in both observational and randomised trials with no effect on clinical outcome 4
- The risk of intracerebral haemorrhage is increased with the combination of aspirin and clopidogrel 4
- Alteplase administered 4.5 to 24 hours after stroke onset resulted in a higher frequency of functional independence at 90 days than standard medical care in patients with mainly mild posterior circulation stroke who did not receive thrombectomy 6