Related Experiment Video
Updated: May 22, 2026
09:21
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Controversies in acute stroke treatment
Mary K Brethour1, Karin V Nyström, Sandra Broughton
1Carle Hospital Stroke Team, Urbana, Illinois, USA.
AACN Advanced Critical Care
|May 1, 2012
Summary
Intravenous tissue plasminogen activator is the sole proven treatment to reduce long-term disability after acute stroke. Despite evidence, adoption remains slow, impacting patient outcomes and highlighting ongoing treatment controversies.
Area of Science:
- Neurology
- Emergency Medicine
- Clinical Practice Guidelines
Background:
- Acute stroke management is rapidly evolving with new therapeutic strategies.
- Intravenous tissue plasminogen activator is the only established treatment reducing 3-month disability post-stroke without increasing mortality.
- Suboptimal adoption of evidence-based acute stroke treatments contributes to preventable patient disability.
Purpose of the Study:
- To explore current controversies in acute ischemic and hemorrhagic stroke management.
- To provide practice recommendations based on existing evidence for acute stroke treatments.
- To enhance the delivery of acute stroke care by addressing treatment gaps and uncertainties.
Main Methods:
- Literature review of evidence supporting acute stroke management strategies.
- Analysis of controversies surrounding treatments like tissue plasminogen activator, blood pressure management, and early mobility.
- Evaluation of evidence for advanced practice nurse-led stroke teams.
Main Results:
- Intravenous tissue plasminogen activator demonstrates efficacy in reducing stroke-related disability.
- Significant controversies persist regarding tissue plasminogen activator use, patient positioning, blood pressure targets in hemorrhage, and innovative stroke team models.
- Evidence quality varies across different acute stroke management controversies.
Conclusions:
- Despite proven benefits, the adoption of intravenous tissue plasminogen activator for acute stroke requires improvement.
- Addressing controversies in acute stroke care is crucial for optimizing patient outcomes.
- Evidence-based recommendations are essential for improving the delivery of acute stroke treatment and reducing patient disability.
Related Concept Videos
01:15Ischemic Stroke ll: Pathophysiology
An ischemic stroke occurs when a cerebral blood vessel becomes obstructed, most often by a thrombus or embolus, interrupting the delivery of oxygen and glucose to brain tissue. Because neurons rely on continuous aerobic metabolism, energy failure begins within minutes of reduced perfusion. The region receiving the least blood flow becomes the infarct core, an area of irreversible cellular death. Surrounding this core lies the penumbra, a zone of hypoperfused but still viable tissue that is...
01:29Stroke: Introduction and Types
A stroke is an acute neurological event caused by the sudden disruption of cerebral blood flow, leading to rapid loss of neuronal function. Neurons depend on continuous oxygen and glucose supply, so even brief interruptions can cause irreversible injury within minutes. Strokes are classified into ischemic and hemorrhagic types.Ischemic StrokeIschemic strokes are most common and occur due to arterial occlusion, depriving brain tissue of oxygen and nutrients. This leads to energy failure, ionic...
01:15Ischemic Stroke l: Introduction
Ischemic stroke is an acute cerebrovascular condition in which blood flow to a brain region is suddenly interrupted, leading to tissue infarction. Neurons depend on continuous oxygen and glucose supply, so even brief reductions in perfusion cause energy failure, ionic imbalance, and irreversible injury. Ischemic strokes are classified into thrombotic and embolic types based on their underlying mechanisms.Thrombotic MechanismsThrombotic stroke develops when a clot forms within a cerebral artery.
01:29Venous Thrombosis III: Interprofessional Care
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
01:29Hemorrhagic Stroke ll: Pathophysiology
A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
01:17Hemorrhagic Stroke l: Introduction
A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...