Guidelines for the treatment of acute ischaemic stroke.
Review published in Neurologia (Barcelona, Spain) (2011)
Abstract
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 °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. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Resumen
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. Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units.
Por qué esto importa para la hirudoterapia
Esta guía de la Sociedad Española de Neurología actualiza el manejo del ictus isquémico agudo basándose en una revisión crítica de la literatura, recomendando la atención organizada en unidades de ictus, el tratamiento de la presión arterial solo por encima de 185/105 mmHg, el manejo de la hiperglucemia y la fiebre, la trombólisis con rtPA intravenoso dentro de las 4.5 horas (trombólisis intraarterial dentro de las 6 horas y trombectomía mecánica dentro de las 8 horas para los ictus de circulación anterior, con ventanas más amplias en la circulación posterior) y la anticoagulación para la trombosis venosa cerebral, al tiempo que considera insuficiente la evidencia para los fármacos neuroprotectores de uso rutinario. Para la ASH, constituye un contexto periférico dentro de la base de evidencia sobre trombosis/anticoagulación: documenta cómo se trata la trombosis arterial aguda de forma farmacológica y procedimental, pero aborda los trombolíticos, antitrombóticos y dispositivos estándar, no la terapia con sanguijuelas medicinales. Como guía de consenso con grados de evidencia (una síntesis de los estudios de otros, con más de una década de antigüedad en la actualidad), únicamente proporciona un marco de referencia y no hace ninguna declaración sobre la hirudoterapia; consulte las guías vigentes para la práctica actual.
Citación
Guidelines for the treatment of acute ischaemic stroke.
Alonso de Leciñana et al. · Neurologia (Barcelona, Spain), 2011
Contexto clínico relacionado
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Añadido a la biblioteca ASH: May 28, 2026 · Última actualización del sitio: June 18, 2026