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    Management of acute ischemic stroke

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    Author
    Phipps, M.S.
    Cronin, C.A.
    Date
    2020
    Journal
    BMJ (Clinical research ed.)
    Publisher
    BMJ Publishing Group
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.1136/bmj.l6983
    Abstract
    Stroke is the leading cause of long term disability in developed countries and one of the top causes of mortality worldwide. The past decade has seen substantial advances in the diagnostic and treatment options available to minimize the impact of acute ischemic stroke. The key first step in stroke care is early identification of patients with stroke and triage to centers capable of delivering the appropriate treatment, as fast as possible. Here, we review the data supporting pre-hospital and emergency stroke care, including use of emergency medical services protocols for identification of patients with stroke, intravenous thrombolysis in acute ischemic stroke including updates to recommended patient eligibility criteria and treatment time windows, and advanced imaging techniques with automated interpretation to identify patients with large areas of brain at risk but without large completed infarcts who are likely to benefit from endovascular thrombectomy in extended time windows from symptom onset. We also review protocols for management of patient physiologic parameters to minimize infarct volumes and recent updates in secondary prevention recommendations including short term use of dual antiplatelet therapy to prevent recurrent stroke in the high risk period immediately after stroke. Finally, we discuss emerging therapies and questions for future research.
    Keyword
    Brain Ischemia
    Clinical Protocols
    Emergency Treatment
    Stroke
    Identifier to cite or link to this item
    https://www.scopus.com/inward/record.uri?eid=2-s2.0-85079334811&doi=10.1136%2fbmj.l6983&partnerID=40&md5=26b42bacacf0de0f370cda80e404fb0b; http://hdl.handle.net/10713/12073
    ae974a485f413a2113503eed53cd6c53
    10.1136/bmj.l6983
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