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Inicio Medicina Clínica (English Edition) Management of acute ischemic stroke
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Vol. 161. Issue 11.
Pages 485-492 (December 2023)
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Vol. 161. Issue 11.
Pages 485-492 (December 2023)
Review
Management of acute ischemic stroke
Abordaje y tratamiento del ictus isquémico en la fase aguda
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Ricardo Rigual
Corresponding author
, Blanca Fuentes, Exuperio Díez-Tejedor
Corresponding author
exuperio.diez@salud.madrid.org

Corresponding authors.
Servicio de Neurología y Centro de Ictus, Instituto de Investigación Sanitaria del Hospital Universitario La Paz – IdiPAZ (Hospital Universitario La Paz – Universidad Autónoma de Madrid), Madrid, Spain
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Table 1. Example of inclusion and exclusion criteria for code activation (Madrid Stroke Care Plan).
Table 2. Summary of indications and contraindications for intravenous thrombolysis.
Table 3. Summary of indications and contraindications for mechanical thrombectomy.
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Abstract

Ischemic stroke is a serious neurological condition that requires urgent attention. As a time-dependent disease, acute stroke management must be coordinated and effective to provide the best treatment as early as possible. The treatment of the acute phase of ischemic stroke includes general measures to ensure patient hemodynamic stability, the use of reperfusion therapies (intravenous thrombolytics and mechanical thrombectomy), improving cerebral protection by monitoring the homeostasis of certain variables as blood pressure, glycemia, temperature, or oxygenation, as well as preventing cerebral and systemic complications. Also, it is necessary an early planning of comprehensive rehabilitation. To prevent early recurrences, control of vascular risk factors and antithrombotic treatment is recommended. The management of patients with acute ischemic stroke aims to reverse initial symptoms, to prevent further brain damage, improve functional outcomes and avoid ischemic recurrences.

Keywords:
Ischemic stroke
Code stroke
Stroke unit
Acute reperfusion therapy
Brain protection
Complications of the acute phase of stroke
Resumen

El ictus isquémico es una enfermedad neurológica grave que precisa una atención urgente. Al ser una enfermedad dependiente del tiempo, la asistencia debe ser coordinada y eficaz para que ofrezca el tratamiento adecuado de la forma más precoz posible. El tratamiento de la fase aguda incluye unas medidas generales para garantizar la estabilidad hemodinámica del paciente, el uso de terapias de reperfusión (trombolíticos intravenosos y tratamiento endovascular mediante trombectomía mecánica) y la contribución a la protección cerebral mediante el control de presión arterial, glucemia, temperatura y oxigenación, así como prevenir complicaciones cerebrales y sistémicas. Se debe planificar de manera precoz el tratamiento rehabilitador del paciente. Para evitar las recurrencias precoces se recomienda tratamiento antitrombótico según la etiología del ictus y el control de los factores de riesgo vascular. Todas estas medidas tienen como objetivo revertir los síntomas iniciales, evitar que progrese la lesión, mejorar la situación funcional del paciente y evitar recurrencias.

Palabras clave:
Ictus isquémico
Código ictus
Unidad de ictus
Tratamiento reperfusor
Protección cerebral
Complicaciones fase aguda ictus

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