Guidelines for the Early Management of Patients With Acute Ischemic Stroke

TLDR

The guidelines provide an overview of current evidence and recommendations for evaluating and treating adults with acute ischemic stroke, emphasizing stroke systems of care from patient recognition to early emergency department and stroke unit management. They are intended for prehospital and hospital providers to guide care of acute ischemic stroke patients within the first 48 hours after onset. The American Stroke Association committee conducted a consensus process, reviewing recent literature, grading evidence with the AHA Stroke Council algorithm, and drafting recommendations on early evaluation, reperfusion strategies, and physiological optimization. The updated guidelines replace the 2007 and 2009 versions, aim to reduce stroke morbidity and mortality, but highlight that many recommendations are based on limited data and call for further research.

Abstract

Background and Purpose— The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators responsible for the care of acute ischemic stroke patients within the first 48 hours from stroke onset. These guidelines supersede the prior 2007 guidelines and 2009 updates. Methods— Members of the writing committee were appointed by the American Stroke Association Stroke Council’s Scientific Statement Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Panel members were assigned topics relevant to their areas of expertise, reviewed the stroke literature with emphasis on publications since the prior guidelines, and drafted recommendations in accordance with the American Heart Association Stroke Council’s Level of Evidence grading algorithm. Results— The goal of these guidelines is to limit the morbidity and mortality associated with stroke. The guidelines support the overarching concept of stroke systems of care and detail aspects of stroke care from patient recognition; emergency medical services activation, transport, and triage; through the initial hours in the emergency department and stroke unit. The guideline discusses early stroke evaluation and general medical care, as well as ischemic stroke, specific interventions such as reperfusion strategies, and general physiological optimization for cerebral resuscitation. Conclusions— Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke remains urgently needed.