From the Guidelines
The treatment for an acute embolic stroke involves prompt administration of recombinant tissue plasminogen activator (rt-PA), specifically alteplase, at a dose of 0.9 mg/kg, with a maximum dose of 90 mg, infused over 60 minutes, initiated within 4.5 hours of symptom onset 1.
Key Components of Treatment
- Intravenous rt-PA: administered as soon as possible after stroke onset, with a dose of 0.9 mg/kg and a maximum dose of 90 mg 1
- Aspirin: recommended to be administered within 24-48 hours of stroke onset, followed by a maintenance dose of 81-325 mg daily 1
- Endovascular Therapy: mechanical thrombectomy with a stent retriever or aspiration device is recommended for eligible patients, initiated as soon as possible after stroke onset, ideally within 6 hours 1
Important Considerations
- Time to Treatment: prompt initiation of treatment is crucial, with the goal of starting intravenous rt-PA within 4.5 hours of symptom onset 1
- Patient Selection: careful selection of patients for endovascular therapy is necessary, taking into account factors such as time to treatment, stroke severity, and eligibility for intravenous rt-PA 1
- Monitoring and Care: close monitoring of patients during and after treatment is essential, with attention to potential complications such as bleeding and stroke recurrence 1
From the Research
Treatment for Acute Embolic Stroke
The treatment for acute embolic stroke involves several options, including:
- Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of symptom onset 2, 3, 4
- Mechanical thrombectomy for patients with large vessel occlusion within 6 hours of symptom onset 2, 3, 5, 4
- Endovascular therapy with mechanical thrombectomy for patients with large artery occlusion who can be treated within 6 hours of symptom onset 5, 4
- Emergency reperfusion in patients with wake-up stroke or delayed presentation (up to 24 hours from last known well in the case of mechanical thrombectomy) 5, 4
Key Considerations
When considering treatment for acute embolic stroke, the following factors are important:
- Time to reperfusion: earlier reperfusion is associated with better clinical outcomes 2, 3, 5, 4
- Collateral status: patients with good collateral flow may have better outcomes with reperfusion therapy 5, 4
- Patient selection: careful selection of patients who may benefit from acute reperfusion therapy within an extended time window requires screening with perfusion brain imaging or emergency brain MRI 5, 4
Treatment Outcomes
Studies have shown that:
- Mechanical thrombectomy can improve outcomes for patients with acute ischemic stroke and large vessel occlusion 2, 3, 5
- Intravenous rtPA can improve outcomes for patients with acute ischemic stroke who present within 4.5 hours of symptom onset 2, 3, 4
- Endovascular therapy with mechanical thrombectomy can be effective in patients with wake-up stroke or delayed presentation (up to 24 hours from last known well) 5, 4