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Mayo Clin Proc. 2018 Apr;93(4):523-538. doi: 10.1016/j.mayocp.2018.02.013.

Diagnosis and Management of Acute Ischemic Stroke.

Author information

1
Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL.
2
Department of Neurology, Mayo Clinic, Rochester, MN.
3
Department of Radiology, Mayo Clinic, Jacksonville, FL.
4
Department of Neurology, University of Florida Health Science Center, Jacksonville, FL.
5
Department of Neurology, Mayo Clinic, Jacksonville, FL.
6
Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL. Electronic address: Tawk.Rabih@mayo.edu.

Abstract

Acute ischemic stroke (AIS) is among the leading causes of death and long-term disability. Intravenous tissue plasminogen activator has been the mainstay of acute therapy. Recently, several prospective randomized trials documented the value of endovascular revascularization in selected patients with large-vessel occlusion within the anterior circulation. This finding has led to a paradigm shift in the management of AIS, including wide adoption of noninvasive neuroimaging to assess vessel patency and tissue viability, with the supplemental and independent use of intravenous tissue plasminogen activator to improve clinical outcomes. In this article, we review the landmark studies on management of AIS and the current position on the diagnosis and management of AIS. The review also highlights the importance of early stabilization and prompt initiation of therapeutic interventions before, during, and after the diagnosis of AIS within and outside of the hospital.

PMID:
29622098
DOI:
10.1016/j.mayocp.2018.02.013
[Indexed for MEDLINE]

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