Guidelines for the treatment of acute ischaemic stroke
Por:
de Lecinana, MA, Egido, JA, Casado, I, Ribo, M, Davalos, A, Masjuan, J, Caniego, JL, Vila, EM, Tejedor, ED, Alvarez-Sabin, J, Arenillas, J, Calleja, S, Castellanos, M, Castillo, J, Diaz-Otero, F, Lopez-Fernandez, JC, Freijo, M, Gallego, J, Garcia-Pastor, A, Gil-Nunez, A, Gilo, F, Irimia, P, Lago, A, Maestre, J, Marti-Fabregas, J, Martinez-Sanchez, P, Molina, C, Morales, A, Nombela, F, Purroy, F, Rodriguez-Yanez, M, Roquer, J, Rubio, F, Segura, T, Serena, J, Simal, P, Tejada, J, Vivancos, J
Publicada:
1 mar 2014
Resumen:
Introduction: Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies.
Development: Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 degrees C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible.
Conclusion: Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intraarterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.
Filiaciones:
de Lecinana, MA:
Hosp Univ Ramon y Cajal, Madrid, Spain
Egido, JA:
Hosp Clin Univ San Carlos, Madrid, Spain
Casado, I:
Hosp San Pedro, Caceres, Spain
Ribo, M:
Hosp Univ Valle Hebron, Barcelona, Spain
Davalos, A:
Hosp Badalona Germans Trias & Pujol, Badalona, Spain
Masjuan, J:
Hosp Univ Ramon y Cajal, Madrid, Spain
Caniego, JL:
Hosp Univ La Princesa, Madrid, Spain
Vila, EM:
Univ Navarra Clin, Pamplona, Spain
Tejedor, ED:
Hosp Univ La Paz, Madrid, Spain
Alvarez-Sabin, J:
Hosp Univ Valle Hebron, Barcelona, Spain
Arenillas, J:
Hosp Univ Clin, Valladolid, Spain
Calleja, S:
Hosp Univ Cent Asturias, Oviedo, Spain
Castellanos, M:
Hosp Josep Trueta, Girona, Spain
Castillo, J:
Hosp Clin Univ, Santiago De Compostela, Spain
Diaz-Otero, F:
Hosp Univ Gregorio Maranon, Madrid, Spain
Lopez-Fernandez, JC:
Hosp Univ Dr Negrin, Las Palmas Gran Canaria, Spain
Freijo, M:
Hosp Univ Basurto, Bilbao, Spain
Gallego, J:
Hosp Gen Navarra, Pamplona, Spain
Garcia-Pastor, A:
Hosp Univ Gregorio Maranon, Madrid, Spain
Gil-Nunez, A:
Hosp Univ Gregorio Maranon, Madrid, Spain
Gilo, F:
Hosp Univ La Princesa, Madrid, Spain
Irimia, P:
Univ Navarra Clin, Pamplona, Spain
Lago, A:
Hosp Univ La Fe, Valencia, Spain
Maestre, J:
Hosp Univ Virgen Nieves, Granada, Spain
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, E-08025 Barcelona, Spain
Martinez-Sanchez, P:
Hosp Univ La Paz, Madrid, Spain
Molina, C:
Hosp Univ Valle Hebron, Barcelona, Spain
Morales, A:
Hosp Univ Virgen Arrixaca, Murcia, Spain
Nombela, F:
Hosp Univ La Princesa, Madrid, Spain
Purroy, F:
Hosp Arnau Vilanova, Lerida, Spain
Rodriguez-Yanez, M:
Hosp Clin Univ, Santiago De Compostela, Spain
Roquer, J:
Hosp Mar, Barcelona, Spain
Rubio, F:
Hosp Univ Bellvitge, Barcelona, Spain
Segura, T:
Hosp Univ Albacete, Albacete, Spain
Serena, J:
Hosp Joseph Trueta, Girona, Spain
Simal, P:
Hosp Clin Univ San Carlos, Madrid, Spain
Tejada, J:
Hosp Univ Leon, Leon, Spain
Vivancos, J:
Hosp Univ La Princesa, Madrid, Spain
Open Access
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