Stroke Treatment, Early Management, and Secondary Prevention

The major breakthrough in acute stroke treatment occurred in 1995, when it was published that IV tPA was effective in reducing disability in acute ischemic patients within 3 hours after onset of symptoms. Attention has since shifted to acute stroke being at the centerpiece of stroke management. Twenty years later, stent retrieval devices were demonstrated to be effective in reducing disability in select patients. Treatment windows are also being extended for appropriately selected patients. Despite the proven efficacy of these interventions, however, most stroke patients will not have access to these treatments for a number of reasons. Regardless, most strokes are attributed to modifiable risk factors, and primary and secondary prevention for cerebrovascular disease should be equally championed. The comprehensive stroke neurologist needs to be skilled at evaluating diagnostic and therapeutic options for not only patients who present early to the hospital but also patients who present past the window for acute intervention. Updates and recommendations for management guidelines which are endorsed by the American Heart Association should be reviewed (http://my.americanheart.org/professional/index.jsp).