Initial management of acute ischemic stroke in the emergency setting: Current evidence
DOI:
https://doi.org/10.33448/rsd-v15i1.50488Keywords:
Stroke, Emergency, Thrombolysis.Abstract
Introduction: Ischemic stroke (IS) is one of the leading causes of mortality and disability worldwide, representing a time-dependent neurological emergency. Proper initial management, especially within the first hours after the onset of symptoms, is critical for reducing neurological sequelae and improving functional outcomes.
Objective: To synthesize current scientific evidence regarding the initial management of ischemic stroke in the emergency context. Method: A narrative literature review based on original articles, clinical trials, systematic reviews, meta-analyses, and national and international guidelines identified in PubMed, SciELO, and the CAPES Portal of Periodicals, using descriptors related to ischemic stroke and initial management in urgent and emergency services. Results: The findings highlight that early recognition of ischemic stroke, the application of structured care protocols, immediate neuroimaging, and appropriate patient selection for reperfusion therapies, such as intravenous thrombolysis and mechanical thrombectomy, are associated with better clinical and functional outcomes. Reducing door-to-needle and door-to-puncture times was identified as a critical factor for therapeutic success, as was the proper initial clinical management of hemodynamic and metabolic parameters. Conclusion: The initial management of ischemic stroke in the emergency setting must be fast, standardized, and evidence-based, essential to minimize morbidity and mortality associated with the disease. The consolidation of institutional protocols, continuous training of teams, and the organization of stroke care networks are key strategies to improve care quality and expand access to effective therapies.
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Copyright (c) 2026 Bruno Coelho Duarte Oliveira, Rodrigo Abrantes Jacinto, Marcus Vinicius Gomes Martins, Luiz Alberto Ferreira Cunha da Câmara, Rafael Abrantes Jacinto, Thiago Assis Venâncio, José Nicolas Andraos Filho
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