Treatment of Acute Ischemic Stroke with Disabling Neurological Deficits in Adults Presenting Within 4.5 Hours
Clinical Scenario
This protocol addresses adults (age ≥18 years) presenting with acute ischemic stroke and disabling neurological deficits within 4.5 hours of symptom onset or last known well who are eligible for intravenous thrombolysis. Speed of treatment is the central determinant of outcome in this time-critical setting.
Treatment Approach
Endovascular thrombectomy is the primary reperfusion intervention in this setting. The complete technique selection, procedural approach, and coordination with intravenous treatment are contained in the full protocol.
Treatment Target
The primary angiographic goal is extended TICI grade 2b / 2c / 3 reperfusion, achieved as early as possible within the therapeutic window to maximise functional benefit.
References
DOI: 10.1161/STR.0000000000000513
- In adult patients with AIS presenting within 4.5 hours of symptom onset or last known well and eligible for IVT, tenecteplase at a dose of 0.25 mg/kg body weight (max 25 mg) or alteplase at a dose of 0.9 mg/kg body weight is recommended to improve functional outcomes.
- In adult patients with AIS with disabling deficits, regardless of NIHSS score, and eligible for IVT, faster treatment improves functional outcomes.
- In patients with AIS due to an LVO, EVT with stent retrievers, contact aspiration, or combination techniques is recommended to achieve rapid and adequate reperfusion.
- In patients with AIS undergoing EVT, reperfusion to an extended TICI grade 2b/2c/3 is recommended as early as possible within the therapeutic window to achieve maximum functional benefit at 90 days.
- In patients with AIS who are eligible for both IVT and EVT, IVT should be administered as rapidly as possible, without observation, to assess clinical response or delay in initiating EVT, to improve treatment times and clinical outcomes.
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