Guideline summary · Nervous system · 8 min read
Acute ischaemic stroke: reperfusion
Time is brain: image fast, thrombolyse eligible patients, and refer large-vessel occlusions for thrombectomy.
Key points
- Check capillary glucose and get non-contrast CT immediately to exclude haemorrhage.
- IV alteplase can be given within 4.5 hours of the patient last being known well.
- Lower blood pressure to below 185/110 mm Hg before thrombolysis and keep it below 180/105 for 24 hours.
- Mechanical thrombectomy is indicated for anterior circulation large-vessel occlusion within 6 hours.
- Selected patients benefit from thrombectomy up to 24 hours using perfusion imaging criteria.
Summary based on the AHA/ASA guidelines for the early management of acute ischaemic stroke (2019 update). A study aid, not a substitute for the current guideline or local protocols.
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