[Acute management and secondary prevention of ischemic stroke]

Stroke is a medical emergency. Intravenous administration of recombinant tissue-type plasminogen activator (rt-PA) within three hours of stroke onset is the only pharmacological treatment proven effective in ischemic stroke. Its efficacy is time dependent. Patients must be carefully selected and treated in dedicated stroke units to reduce the risk of hemorrhage. Early treatment in dedicated stroke units reduces mortality and disability, independent of any specific treatment. Secondary prevention includes antiplatelet therapy and successful control of all risk factors (hypertension, diabetes, tobacco use, and hyperlipidemia). Carotid endarterectomy may be considered if the residual disability is not serious. Lowering blood pressure is beneficial even when initial blood pressure is normal. Lowering LDL-C with statins after ischemic stroke reduces the risk of recurrent stroke and coronary events.