Treatment of acute ischemic cerebrovascular diseases

1. Big picture

Acute ischemic stroke is a neurological emergency caused by sudden reduction or occlusion of cerebral arterial blood flow. The treatment goal is simple: save the ischemic penumbra before it becomes infarcted brain. The lecture’s key sentence is: “Time is brain.” In practical exam language: first recognize stroke, exclude hemorrhage, identify whether there is a large-vessel occlusion, open the vessel if possible, and prevent complications.

Current acute ischemic stroke care is built around two reperfusion therapies: intravenous thrombolysis and endovascular mechanical thrombectomy. Updated AHA/ASA guidance supports alteplase or tenecteplase within the 4.5-hour thrombolysis window, rapid treatment of disabling deficits, selected extended-window thrombolysis using advanced imaging, and broader use of endovascular thrombectomy for large-vessel occlusion, including basilar artery occlusion in selected patients.