Hyperacute Management of Ischemic Strokes: JACC Focus Seminar

Area of Science:

• Neurology
• Cardiovascular Medicine
• Emergency Medicine

Background:

• Acute ischemic stroke is a primary cause of long-term disability and mortality globally.
• Intravenous tissue plasminogen activator has been a standard treatment for over two decades but has limitations.
• Limitations include a narrow therapeutic window, contraindications, and reduced efficacy in large vessel occlusions.

Purpose of the Study:

• To review recent advancements in acute ischemic stroke treatment.
• To discuss updates in both thrombolytic and endovascular therapies.
• To highlight new patient selection criteria for extended treatment windows using perfusion imaging.

Main Methods:

• Review of current literature and recent clinical trial data.
• Analysis of thrombolytic treatment protocols and their limitations.
• Evaluation of endovascular mechanical thrombectomy techniques for large artery occlusion.
• Assessment of perfusion imaging in patient selection for extended time windows.

Main Results:

• Endovascular mechanical thrombectomy has revolutionized stroke treatment for large vessel occlusions.
• Perfusion imaging aids in selecting patients for treatment in extended time windows.
• Recent trials demonstrate improved recanalization rates and clinical outcomes with combined therapies.

Conclusions:

• Mechanical thrombectomy represents a significant advancement in managing acute ischemic stroke.
• Optimizing patient selection with advanced imaging is crucial for expanding treatment eligibility.
• Future research should focus on refining treatment protocols and expanding access to these life-changing therapies.