Advancements in the management of acute ischemic stroke: A narrative review

Abstract

Primary literature detailing updated management principles of acute ischemic stroke outpaces current guidelines, resulting in heterogenous practices. Recent advancements in neuroimaging have shifted treatment from a time‐based approach to an individualized, image‐guided appraisal directed by the presence or absence of salvageable brain tissue. In addition, tenecteplase appears to be a safe and effective for the treatment of acute ischemic stroke and is becoming an attractive agent due to its practical administration. Several factors must be accounted for when implementing tenecteplase into the health‐system including cost, education, and changes in clinician workflows. Larger studies with broad patient populations are needed to more definitively evaluate whether intravenous thrombolytics should be used in combination with endovascular thrombectomy in patients with anterior large‐vessel occlusions. Although debate regarding the safety and efficacy of various endovascular therapies, delays encountered in the identification, triage, and care of acute ischemic stroke patients increase the likelihood of necrotic core lesion development and loss of salvageable penumbra.

Health Factors Associated With Development and Severity of Poststroke Dysphagia: An Epidemiological Investigation

“…Given this, we could hypothesize that these findings suggest that advances in acute‐stroke care between 2010 and 2015 resulted in fewer severe strokes overall, with fewer individuals with resulting dysphagia in 2015 as compared with 2010. 36 , 37 This idea is supported by the breakdown of dysphagia severity categories across years showing that there was a greater proportion, overall, of individuals in 2015 as compared with 2010 who had dysphagia but did not require alternative access to nutrition (Table 1 ).…”

Expert Consensus on Improving Stroke Care Ecosystem in India

“…Ongoing trials, that is, ATTEST2, BRIDGE-TNK, Nor-TEST 2 part B, TEMPO 2 will evaluate its efficacy and safety. 105 TIMELESS trials failed to show benefit beyond 4.5 hours for Tenecteplase although results of other studies evaluating benefit beyond 4.5 hours are awaited. 106 Tenecteplase is now approved for use up to 4.5 hours of stroke onset in India.…”

Shaping the Future of Cardiac Wellness: Exploring Revolutionary Approaches in Disease Management and Prevention

“…The initial management of ischemic stroke may include the administration of intravenous tissue plasminogen activator (tPA) within 3-4.5 hours of symptom onset, which can dissolve the clot causing the stroke and restore blood flow to the brain. Mechanical thrombectomy, which involves the removal of the clot using a catheter inserted through the groin, may be considered in certain cases [83]. The management of hemorrhagic stroke involves the identification and treatment of the underlying cause of the bleeding, such as hypertension or aneurysm.…”