Paradigm shift in the management of Acute Ischemic stroke

The management of acute ischemic stroke has undergone a dramatic change following the introduction of recombinant tissue plasminogen activator in 1996. Since then there have been a number of trials to studying the efficacy of endovascular treatment in acute ischemic stroke as well. These trials have proved a clear benefit of endovascular treatment in acute ischemic stroke in those patients with a large vessel occlusion. 60-70% of the patients had a good outcome at the end of three months. Current guidelines state that patients with acute ischemic stroke presenting in the window period of 4.5 hours should be considered for thrombolysis. A baseline imaging with a CT Brain along with CT Angiogram of neck and intracranial vessels should be done. If there is no contraindications for IV TPA patients should receive the same. If there is evidence of a large vessel occlusion on the CT Angiogram the patient should be considered for endovascular treatment along with IVT. The window for endovascular treatment can be extended up to 6 hours. In this article we have reviewed all the major trials in the management of acute ischemic stroke from the TPA trials to the latest endovascular trials.