Treatment of Acute Ischaemic Stroke

Abstract

The management of acute cerebral infarct has considerably changed in recent years, thanks to new techniques combining imaging and new treatments. The formalization of a specific multidisciplinary course (emergency physicians, neurologists, radiologists and resuscitators) allowed a real gain of efficiency. A real race against the clock starts at the first clinical signs suggestive of stroke. Rapid access to a NeuroVascular Unit (UNV) is crucial in the prognosis, allowing to reduce morbidity and disability, apart from any specific recanalization treatment (Stroke Center effect). IV thrombolysis with alteplase administered within 4 h 30 min of cerebral infarction remained until 2015, the only specific reference treatment. Since then, mechanical thrombectomy within 6 h must be associated with proximal occlusion. These new data have a significant impact on the early hours of organizational planning, defining two patient referral strategies: direct transfer (Mother Ship) in a UNVCenter for Interventional NeuroRadiology (NRI) or reception in a UNV and secondary transfer in a NRI center, if necessary (Drip and Ship). Very recently, studies report the benefit of thrombectomy up to 24 h from the onset of symptoms in highly selected patients. These data remain to be confirmed.