Guidelines for the treatment of acute ischaemic stroke

Data de publicació: 01/03/2014

Autors de IIS La Fe

• Antonio Davalos Errando

  Autor

• Aida Lago Martín

  Autor

• Neira Morales Alcaide

  Autor

• Raquel Serena Marti

  Autor

• Jose Luis Vivancos Bono

  Autor

Autors aliens a IIS La Fe

• Alonso de Leciñana M
• Egido JA
• Casado I
• Ribó M
• Masjuan J
• Caniego JL
• Martínez Vila E
• Díez Tejedor E
• ad hoc committee of the SEN Study Group for Cerebrovascular Diseases
• Fuentes B
• Álvarez-Sabin J
• Arenillas J
• Calleja S
• Castellanos M
• Castillo J
• Díaz-Otero F
• López-Fernández JC
• Freijo M
• Gállego J
• García-Pastor A
• Gil-Núñez A
• Gilo F
• Irimia P
• Maestre J
• Martí-Fábregas J
• Martínez-Sánchez P
• Molina C
• Nombela F
• Purroy F
• Rodríguez-Yañez M
• Roquer J
• Rubio F
• Segura T
• Simal P
• Tejada J
• Spanish Neurological Society

Grups d'Investigació

• Hemostasia, Trombosis, Arteriosclerosis y Biología vascular

  

  Investigador Principal

  Pilar Medina Badenes

Abstract

Introduction: Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. Development: Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 degrees C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. Conclusion: Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intraarterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.

Keywords

• Cerebral infarct; Ischaemic stroke; Thrombolysis; Brain protection; Stroke units; Cerebral venous thrombosis