This is a recent updated version of the ACC/AHA Guidelines regarding management of acute ischemic stroke. For outpatient clinicians the most important point is that patients benefit from antithrombotic measures up to 4.5 hours after the onset of symptoms. James W. Mold, MD, MPH

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Guideline title 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Release date January 24, 2018

Prior version 2013

Developer American Heart Association (AHA)/American Stroke Association (ASA)

Funding source AHA/ASA

Target population Adult patients with acute arterial ischemic stroke

Major recommendations

Regional systems of stroke care should be developed that include health care facilities providing initial emergency care and those capable of endovascular stroke treatment, to which rapid transport can be arranged when appropriate (high-quality evidence; strong recommendation).
Intravenous alteplase is recommended for patients meeting detailed eligibility requirements within 3 hours of ischemic stroke onset (high-quality evidence; strong recommendation) and between 3 and 4.5 hours of ischemic stroke onset (moderate-quality evidence; strong recommendation).
Mechanical thrombectomy with a stent retriever is recommended for patients with a causative occlusion of the internal carotid artery or proximal middle cerebral artery with at least moderately severe presenting stroke deficits (National Institutes of Health Stroke Scale [NIHSS] score ≥6) and absence of evidence of widespread established infarction on brain imaging, when endovascular treatment can be initiated within 6 hours of symptom onset (high-quality evidence; strong recommendation).
Mechanical thrombectomy with a stent retriever is also recommended for certain acute ischemic stroke (AIS) patients presenting at later times (moderate- to high-quality evidence; strong recommendation).

Author/s:

Cifu, A.S., Brorson, J.R.