Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Abstract

Background and Purpose— The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations in a single document for clinicians caring for adult patients with acute arterial ischemic stroke. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 Acute Ischemic Stroke (AIS) Guidelines and are an update of the 2018 AIS Guidelines. Methods— Members of the writing group were appointed by the American Heart Association (AHA) Stroke Council’s Scientific Statements Oversight Committee, representing various areas of medical expertise. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. An update of the 2013 AIS Guidelines was originally published in January 2018. This guideline was approved by the AHA Science Advisory and Coordinating Committee and the AHA Executive Committee. In April 2018, a revision to these guidelines, deleting some recommendations, was published online by the AHA. The writing group was asked review the original document and revise if appropriate. In June 2018, the writing group submitted a document with minor changes and with inclusion of important newly published randomized controlled trials with >100 participants and clinical outcomes at least 90 days after AIS. The document was sent to 14 peer reviewers. The writing group evaluated the peer reviewers’ comments and revised when appropriate. The current final document was approved by all members of the writing group except when relationships with industry precluded members from voting and by the governing bodies of the AHA. These guidelines use the American College of Cardiology/AHA 2015 Class of Recommendations and Level of Evidence and the new AHA guidelines format. Results— These guidelines detail prehospital care, urgent and emergency evaluation and treatment with intravenous and intra-arterial therapies, and in-hospital management, including secondary prevention measures that are appropriately instituted within the first 2 weeks. The guidelines support the overarching concept of stroke systems of care in both the prehospital and hospital settings. Conclusions— These guidelines provide general recommendations based on the currently available evidence to guide clinicians caring for adult patients with acute arterial ischemic stroke. In many instances, however, only limited data exist demonstrating the urgent need for continued research on treatment of acute ischemic stroke.

Ischaemic stroke in the time of coronavirus disease 2019

“…Two to three out of 10 patients die as a consequence of it and about one third remains functionally dependent 2 . As we know, the likelihood of a favourable outcome in this disease relies heavily on patients presenting promptly after symptoms onset and on hospitals providing immediate access to optimized stroke care 3,4 .…”

Organizing Healthcare for Optimal Acute Ischemic Stroke Treatment

“…The following major time benchmarks for acute ischemic stroke treatment are all tracked by international standard of recommendations, and they were chosen by a group of experts at the National Institutes of Health; they have subsequently been adopted by the ASA: 39 • Door to medical doctor: 10 minutes.…”

Automated Hierarchy Evaluation System of Large Vessel Occlusion in Acute Ischemia Stroke

“…Large vessel occlusion (LVO) accounts for approximately only one-third of AIS but is responsible for 60% of stroke-related disability and 90% of stroke-related deaths (Malhotra et al, 2017). Recent advances in endovascular thrombectomy (EVT) for treatment of AIS caused by LVO have been widely accepted around the world (Powers et al, 2019). Similar to intravenous thrombolysis, rapid access to EVT, preferably within 6 h from symptom onset, remains paramount to ensure functional recovery (Saver et al, 2016;Powers et al, 2019).…”

“…Recent advances in endovascular thrombectomy (EVT) for treatment of AIS caused by LVO have been widely accepted around the world (Powers et al, 2019). Similar to intravenous thrombolysis, rapid access to EVT, preferably within 6 h from symptom onset, remains paramount to ensure functional recovery (Saver et al, 2016;Powers et al, 2019). As EVT is only available in specialized centers, interhospital transfer is frequently required, leading to an average treatment delay of 142 min and millions of neuron loss (Saver, 2006;Saver et al, 2016).…”