Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke

HomeStrokeVol. 50, No. 12Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBGuidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke John J. Warner, MD, Robert A. Harrington, MD, Ralph L. Sacco, MD and Mitchell S.V. Elkind, MD John J. WarnerJohn J. Warner Correspondence to John J. Warner, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. Email E-mail Address: [email protected] From the University of Texas Southwestern Medical Center, Dallas (J.J.W.) Search for more papers by this author , Robert A. HarringtonRobert A. Harrington Stanford University, CA (R.A.H.) Search for more papers by this author , Ralph L. SaccoRalph L. Sacco University of Miami, Miller School of Medicine, FL (R.L.S.) Search for more papers by this author and Mitchell S.V. ElkindMitchell S.V. Elkind Columbia University, NY (M.S.V.E.). Search for more papers by this author Originally published30 Oct 2019https://doi.org/10.1161/STROKEAHA.119.027708Stroke. 2019;50:3331–3332is related toGuidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke AssociationOther version(s) of this articleYou are viewing the most recent version of this article. Previous versions: October 30, 2019: Ahead of Print See related article, p e344In this issue, you will find the current version of the American Heart Association (AHA)/American Stroke Association (ASA) “Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke,” the product of the devoted work of experts in Vascular Neurology who made up its Writing Committee. Because of the interest of the stroke community in these guidelines, we want to clarify here the processes leading to its publication as an update to our 2018 Guidelines addressing this important area of clinical practice.The previous version of the "Guidelines for the Early Management of Acute Ischemic Stroke" was originally published in late January 2018 and included important information regarding the substantial advances related to the use of mechanical thrombectomy, as well as an extensive range of recommendations regarding virtually all other areas of acute ischemic stroke management. The Writing Committee had a great deal of data related to clinical science to review and consolidate. Moreover, their work was accomplished during a time period in which the acute stroke scientific literature was evolving rapidly and a new modified system for categorizing recommendations in AHA/ASA Guidelines was being implemented. The AHA/ASA timeline and the plan to have the guidelines and their critical recommendations on thrombectomy available for stroke healthcare providers released during the International Stroke Conference in February 2018 also led to less time available for review.While the Guidelines were well received in general, there were some concerns raised within the stroke community about certain recommendations. The AHA/ASA and some of the partner organizations felt these concerns warranted further consideration to assure that a small number of objections not threaten the overall value of these comprehensive recommendations. A special review panel was constituted by the AHA/ASA President, comprised of AHA/ASA stroke experts and volunteers with guideline development expertise. The panel recommended that the stroke community would be best served by holding a small number of recommendations aside for further consideration and by clarification, particularly regarding the new classification of recommendations. A modified version of the original guideline replaced the original document in April 2018,1 holding aside 7 specific recommendations related to acute stroke care and all of Section 6 (which addressed diagnostic and therapeutic approaches for secondary stroke prevention to be initiated during the acute phase of ischemic stroke care) for further review and discussion by the Writing Committee. This modified version was affirmed and endorsed by the original partners listed above.Over the course of the next 16 months, the Writing Committee thoroughly reexamined the original document, adjusted it to the current American Heart Association system of designating Classes of Recommendation and Levels of Evidence to match other American Heart Association Guidelines, responded to issues brought forward by the panel, and expanded the evidence base by examining new randomized controlled trials published since the original trials were considered. The Writing Committee produced a revised document, with additional recommendations, clarifications, and modifications throughout. A new version of Section 6 was included. The revised document was again thoroughly reviewed, and comments were addressed by the Writing Committee, with subsequent adjudication by the AHA/ASA Stroke Statements Oversight Committee. As the guideline was being finalized, the Writing Committee brought forward an additional 7 newly published randomized controlled trials relevant to topics addressed in the guideline. These were discussed with the Stroke Statements Oversight Committee, and it was determined that 3 of them provided information important enough to be included. The final document was reviewed and approved by American Heart Association Science Advisory and Coordinating Committee and Executive Committee, as well as by the affirming and endorsing partner organizations listed above. The intent of the rigorous process for generating these evidence-based recommendations is to always provide consistent and clear guidance to improve the quality of stroke care; so we suggest that you update your considerations of this area of stroke care and your educational presentations with this new document and the evidence presented herein.We especially wish to thank the Writing Committee, whose extensive work in generating both the original guidelines and this updated version has been marked by a tireless commitment to providing the best possible guidance for their colleagues. As all those working in this field know, great stroke care results from teamwork and collaboration, and their willingness to continue their efforts throughout this extended period of involvement is a manifestation of their devotion to the stroke care community and most importantly, the many patients who will benefit from their efforts.DisclosuresDr Harrington reports grants from Sanofi Aventis, AstraZeneca, Portola, Janssen, BMS, and Novartis outside the submitted work and belongs to American Heart Association President and Board of Directors (unpaid) and Stanford Healthcare Board of Directors.FootnotesThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.Correspondence to John J. Warner, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390. Email john.[email protected]eduReferences1. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al; American Heart Association Stroke Council. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.Stroke. 2018; 49:e46–e110. doi: 10.1161/STR.0000000000000158LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited ByTakahashi E, Schwamm L, Adeoye O, Alabi O, Jahangir E, Misra S and Still C (2022) An Overview of Telehealth in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, Circulation, 146:25, (e558-e568), Online publication date: 20-Dec-2022. Qin J, He Q and Zhang Z (2022) Detrimental effect of increased blood pressure variability on clinical outcome in acute ischemic stroke treated with reperfusion therapy: a case control study, BMC Neurology, 10.1186/s12883-022-02605-5, 22:1, Online publication date: 1-Dec-2022. Kumi F, Bugri A, Adjei S, Duorinaa E and Aidoo M (2022) Quality of acute ischemic stroke care at a tertiary Hospital in Ghana, BMC Neurology, 10.1186/s12883-021-02542-9, 22:1, Online publication date: 1-Dec-2022. Wang Y, Xin Y, Wang X, Zhang Y, Zhang Y, Wang Y, Peng L and Wu Y (2022) Ambient fine particulate pollution hysteresis triggers wake-up stroke and rapidly triggers non-wake-up stroke: a case-crossover study, Environmental Science and Pollution Research, 10.1007/s11356-022-21458-6, 29:54, (82243-82255), Online publication date: 1-Nov-2022. Tan Z, Parsons M, Bivard A, Sharma G, Mitchell P, Dowling R, Bush S, Churilov L, Xu A and Yan B (2022) Comparison of Computed Tomography Perfusion and Multiphase Computed Tomography Angiogram in Predicting Clinical Outcomes in Endovascular Thrombectomy, Stroke, 53:9, (2926-2934), Online publication date: 1-Sep-2022. Shah S, Hatfield J, Fuller M, Ohnuma T, Luke James M, Bartz R, Raghunathan K, Komisarow J and Krishnamoorthy V (2022) Mechanical thrombectomy for perioperative ischemic stroke following elective inpatient surgery in the United States, Journal of Clinical Neuroscience, 10.1016/j.jocn.2022.05.009, 101, (100-105), Online publication date: 1-Jul-2022. Chu Y, Shen G, Ma G, Xu X, Lu S, Jiang L, Liu S, Shi H and Wu F (2022) Diagnostic accuracy of using Alberta Stroke Program Early Computed Tomography Score on CT perfusion map to predict a target mismatch in patients with acute ischemic stroke, Neuroradiology, 10.1007/s00234-021-02892-8, 64:7, (1321-1330), Online publication date: 1-Jul-2022. Woo S, Kim Y and Kim H (2022) The incidence of unexpected delays in uploading outside radiologic images in the transfer of patients with major trauma, Journal of Trauma and Injury, 10.20408/jti.2021.0039, 35:2, (92-98), Online publication date: 30-Jun-2022. Chen J, Lin X, Yao C, Bingwa L, Wang H, Lin Z, Jin K, Zhuge Q and Yang S (2022) Transplantation of Roxadustat‐preconditioned bone marrow stromal cells improves neurological function recovery through enhancing grafted cell survival in ischemic stroke rats, CNS Neuroscience & Therapeutics, 10.1111/cns.13890 Dodig D, Matana Kaštelan Z, Bartolović N, Jurković S, Miletić D and Rumboldt Z (2021) Virtual monoenergetic dual-energy CT reconstructions at 80 keV are optimal non-contrast CT technique for early stroke detection, The Neuroradiology Journal, 10.1177/19714009211047449, 35:3, (337-345), Online publication date: 1-Jun-2022. Equiza J, de la Riva P, Angel Larrea J, Marta-Enguita J, Albájar I, Lüttich A, Garmendia E, Alonso M, de Arce A, Díez N, Gonzalez F, Iruzubieta P, Sulibarria N, Puig J and Martínez-Zabaleta M (2022) Impact on functional outcome of an adaptive Stroke Unit based system of care for patients undergoing endovascular treatment during pandemic times, European Stroke Journal, 10.1177/23969873221098269, (239698732210982) Ma G, Sun X, Cheng H, Burgin W, Luo W, Jia W, Liu Y, He W, Geng X, Zhu L, Chen X, Shi H, Xu H, Zhang L, Wang A, Mo D, Ma N, Gao F, Song L, Huo X, Deng Y, Liu L, Luo G, Jia B, Tong X, Liu L, Ren Z, Miao Z, Gui L, Wang T, Ma X, Yang C, Gui L, Song C, Peng Y, Wu J, Zhao S, Zhao J, Zhou Z, Li Y, Jing P, Yang L, Zhao Q, Liu Y, Peng X, Gao Q, Guo Z, Chen W, Li W, Cheng X, Xu Y, Zhang Y, Zhang G, Lu Y, Lu X, Wang D, Wang Y, Li H, Hua Y, Geng D, Yuan H, Wang H, Yang H, Wang Z, Wei L, Liufu X, Shi X, Li J, Yang W, Jing W, Yong X, Wang L, Li C, Cao Y, Zhu Q, Zhang P, Luo X, Chen S, Peng W, Wang L, Wen X, Shi S, Wang W, Bo W, Yuan P, Wang D, Guan H, Liang W, Ma D, Chen L, Xiao Y, Xie X, Shi Z, Zeng X, Su F, Chang M, Yin J, Sun H, Li C, Bi Y, Xie G, Zhao Y, Wang C, Zhang P, Wang X, Li D, Liang H, Chen Z, Wang Y, Wang Y, Yin L, Qiu H, Wei J, Sun Y, Feng X, Wu W, Gao L, Ai Z, Lan T, Ding L, Liang Q, Wang Z, Yang J, Xu P, Dong W, Zheng Q, Zhu Z, Zhao L, Meng Q, Wei Y, Chen X, Wang W, Sun D, Yan Y, Yuan G, Yang Y, Zhou J, Yang Z, Zhang Z, Guan N and Wang H (2022) Combined Approach to Eptifibatide and Thrombectomy in Acute Ischemic Stroke Because of Large Vessel Occlusion: A Matched-Control Analysis, Stroke, 53:5, (1580-1588), Online publication date: 1-May-2022. Wen X, Ye G, Li Z, Wang H, Wang D, Pan Z and Chen M (2022) First-line contact aspiration versus first-line stent retriever for acute ischemic stroke with M2 occlusion: A systematic review and meta-analysis, Clinical Neurology and Neurosurgery, 10.1016/j.clineuro.2022.107215, 216, (107215), Online publication date: 1-May-2022. Sapra H (2022) “No Time to Die” – Saving the Neurons, Indian Journal of Critical Care Medicine, 10.5005/jp-journals-10071-24221, 26:5, (537-538), Online publication date: 30-Apr-2022. Elder T, Verhey L, Schultz H, Smith E and Adel J (2022) Cervical carotid occlusion in acute ischemic stroke: Should we give tPA?, Surgical Neurology International, 10.25259/SNI_176_2022, 13, (177) Martini B and Schalk A (2021) Comparison of premade clevidipine and pharmacy-prepared nicardipine in time to goal systolic blood pressure in acute cerebrovascular accident, American Journal of Health-System Pharmacy, 10.1093/ajhp/zxab394, 79:9, (e110-e116), Online publication date: 19-Apr-2022. Wolff L (2022) Editorial comment on “Automated quantitative lesion water uptake in acute stroke is a predictor of malignant cerebral edema”, European Radiology, 10.1007/s00330-022-08544-6, 32:4, (2769-2770), Online publication date: 1-Apr-2022. Deng J, Li L, Cao F, Wang F, Wang H, Shi H, Shen L, Zhao F and Zhao Y (2022) Systemic Glycemic Variation Predicts Mortality of Acute Ischemic Stroke After Mechanical Thrombectomy: A Prospective Study Using Continuous Glucose Monitoring, Frontiers in Neurology, 10.3389/fneur.2022.817033, 13 Mojtahedi M, Kappelhof M, Ponomareva E, Tolhuisen M, Jansen I, Bruggeman A, Dutra B, Yo L, LeCouffe N, Hoving J, van Voorst H, Brouwer J, Terreros N, Konduri P, Meijer F, Appelman A, Treurniet K, Coutinho J, Roos Y, van Zwam W, Dippel D, Gavves E, Emmer B, Majoie C and Marquering H (2022) Fully Automated Thrombus Segmentation on CT Images of Patients with Acute Ischemic Stroke, Diagnostics, 10.3390/diagnostics12030698, 12:3, (698) Jin R, Wang M, Zhong W, Kissinger C, Villafranca J and Li G (2022) J147 Reduces tPA-Induced Brain Hemorrhage in Acute Experimental Stroke in Rats, Frontiers in Neurology, 10.3389/fneur.2022.821082, 13 Shi T, Zhang Z, Jin B, Wang J, Wu H, Zheng J and Hu X (2022) Choice of intravenous thrombolysis therapy in patients with mild stroke complaining of acute dizziness, The American Journal of Emergency Medicine, 10.1016/j.ajem.2021.11.020, 52, (20-24), Online publication date: 1-Feb-2022. Matsoukas S, Morey J, Lock G, Chada D, Shigematsu T, Marayati N, Delman B, Doshi A, Majidi S, De Leacy R, Kellner C and Fifi J (2022) AI software detection of large vessel occlusion stroke on CT angiography: a real-world prospective diagnostic test accuracy study, Journal of NeuroInterventional Surgery, 10.1136/neurintsurg-2021-018391, (neurintsurg-2021-018391) Christopher-Dwyer K, Scanlon K and Crimlisk J (2022) Critical Care Resource Nurse Team, Dimensions of Critical Care Nursing, 10.1097/DCC.0000000000000501, 41:1, (46-53), Online publication date: 1-Jan-2022. Anagnostakou V, Epshtein M, Kühn A, King R, Puri A and Gounis M (2022) Preclinical modeling of mechanical thrombectomy, Journal of Biomechanics, 10.1016/j.jbiomech.2021.110894, 130, (110894), Online publication date: 1-Jan-2022. Herath H, Rodrigo C, Alahakoon A, Ambawatte S, Senanayake S, Senanayake B and Fernando A (2021) Outcomes of stroke patients undergoing thrombolysis in Sri Lanka; an observational prospective study from a low-middle income country, BMC Neurology, 10.1186/s12883-021-02475-3, 21:1, Online publication date: 1-Dec-2021. Kaesmacher J, Meinel T, Kurmann C, Zaidat O, Castonguay A, Zaidi S, Mueller-Kronast N, Kappelhof M, Dippel D, Soudant M, Bracard S, Hill M, Goyal M, Strbian D, Heiferman D, Ashley W, Anadani M, Spiotta A, Dobrocky T, Piechowiak E, Arnold M, Goeldlin M, Seiffge D, Mosimann P, Mordasini P, Gralla J and Fischer U (2021) Safety and efficacy of intra-arterial fibrinolytics as adjunct to mechanical thrombectomy: a systematic review and meta-analysis of observational data, Journal of NeuroInterventional Surgery, 10.1136/neurintsurg-2020-016680, 13:12, (1073-1080), Online publication date: 1-Dec-2021. Tekle W and Hassan A (2021) Intracranial Atherosclerotic Disease, Neurology, 10.1212/WNL.0000000000012805, 97:20 Supplement 2, (S145-S157), Online publication date: 16-Nov-2021. Kulesh A (2021) Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view, Neurology, Neuropsychiatry, Psychosomatics, 10.14412/2074-2711-2021-5-4-13, 13:5, (4-13) Su D, Zhang Y, Wang A, Shao D, Xu F, Dong M, Zhao L, Hu Y and Luo H (2021) Efficacy and tolerability of selective serotonin reuptake inhibitors on promoting motor recovery after stroke:meta-analysis of randomized controlled trials, Expert Review of Neurotherapeutics, 10.1080/14737175.2021.1982696, 21:10, (1179-1189), Online publication date: 3-Oct-2021. Zeng M, Zhou H, He Y, Du H, Yin J, Hou Y, Zhu J, Zhang Y, Shao C, Yang J and Wan H (2021) Danhong injection enhances the therapeutic effect of mannitol on hemispheric ischemic stroke by ameliorating blood-brain barrier disruption, Biomedicine & Pharmacotherapy, 10.1016/j.biopha.2021.112048, 142, (112048), Online publication date: 1-Oct-2021. Darkwah Oppong M, Wrede K, Müller D, Santos A, Rauschenbach L, Dinger T, Ahmadipour Y, Pierscianek D, Chihi M, Li Y, Deuschl C, Sure U and Jabbarli R (2021) PaCO2-management in the neuro-critical care of patients with subarachnoid hemorrhage, Scientific Reports, 10.1038/s41598-021-98462-2, 11:1 Abreu P, Magalhães R, Baptista D, Azevedo E and Correia M (2021) Admission and Readmission/Death Patterns in Hospitalized and Non-hospitalized First-Ever-in-a-Lifetime Stroke Patients During the First Year: A Population-Based Incidence Study, Frontiers in Neurology, 10.3389/fneur.2021.685821, 12 Kröger H, Nikoubashman O, Dimitrov I, Yousefian Jazi E, Schürmann K, Wiesmann M, Schulz J and Reich A (2021) StrokeWatch: An Instrument for Objective Standardized Real-Time Measurement of Door-to-Needle Times in Acute Ischemic Stroke Treatment, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2021.105962, 30:9, (105962), Online publication date: 1-Sep-2021. Zeng M, Shao C, Zhou H, He Y, Li W, Zeng J, Zhao X, Yang J and Wan H (2021) Protocatechudehyde improves mitochondrial energy metabolism through the HIF1α/PDK1 signaling pathway to mitigate ischemic stroke-elicited internal capsule injury, Journal of Ethnopharmacology, 10.1016/j.jep.2021.114232, 277, (114232), Online publication date: 1-Sep-2021. Chen C, Song L, Yang J, Lindley R, Robinson T, Arima H, Chalmers J, Anderson C and Wang X (2021) Regional Differences in Early BP Management After Acute Ischemic Stroke in the ENCHANTED International Randomized Controlled Trials, Frontiers in Neurology, 10.3389/fneur.2021.687862, 12 Li F, Liu P, Huang Y, Li L, Zhang S, Yang Z, Wang R, Tao Z, Han Z, Fan J, Zheng Y, Zhao H and Luo Y (2021) The Incremental Prognostic Value of Hepatocyte Growth Factor in First-Ever Acute Ischemic Stroke: An Early Link Between Growth Factor and Interleukins, Frontiers in Neurology, 10.3389/fneur.2021.691886, 12 Zhong W, Zhou Y, Zhang K, Yan S, Sun J and Lou M (2021) Minor Non-Disabling Stroke Patients with Large Vessel Severe Stenosis or Occlusion Might Benefit from Thrombolysis, Brain Sciences, 10.3390/brainsci11070945, 11:7, (945) Lim J, Vedicherla S, Chan S, Primalani N, Tan A, Saffari S and Lee L Decompressive craniectomy for internal carotid artery and middle carotid artery infarctions: a long-term comparative outcome study, Neurosurgical Focus, 10.3171/2021.4.FOCUS21123, 51:1, (E10) Talavera B, Gómez-Vicente B, Martínez-Galdámez M, López-Cancio E, García-Cabo C, Castellanos M, Roel A, Tejada-Meza H, Marta-Moreno J, Pérez-Lázaro C, Navarro-Pérez M, Bravo-Anguiano Y, Bártulos-Iglesias M, Tejada-García J, Rodrigo-Stevens G, Martínez-Zabaleta M, de la Riva P, Timiraos-Fernández J, del Mar Freijo M, Luna A, García-Sánchez J, del Carmen Gil-Alzueta M, Palacio-Portilla E, Jiménez-López Y, López-Mesonero L, Redondo-Robles L, Mayo-Iscar A and Arenillas J (2021) Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke, Stroke, 52:7, (2210-2217), Online publication date: 1-Jul-2021. Qiu Y, Zhang C, Chen A, Wang H, Zhou Y, Li Y and Hu B (2021) Immune Cells in the BBB Disruption After Acute Ischemic Stroke: Targets for Immune Therapy?, Frontiers in Immunology, 10.3389/fimmu.2021.678744, 12 Yao X, Yang W, Ren Z, Zhang H, Shi D, Li Y, Yu Z, Guo Q, Yang G, Gu Y, Zhao H and Ren K (2021) Neuroprotective and Angiogenesis Effects of Levetiracetam Following Ischemic Stroke in Rats, Frontiers in Pharmacology, 10.3389/fphar.2021.638209, 12 Shi W, Kong X, Tian W, Yan Y, Chen Y and Ramirez G (2021) Segmentation Algorithm for Intracranial Magnetic Resonance Images for Cerebral Stroke Identification and Nursing Evaluation, Scientific Programming, 10.1155/2021/9996977, 2021, (1-8), Online publication date: 10-May-2021. Wang L, Jiang J, Zhou T, Xue X, Cao Y and Xu Z (2021) Improvement of Cerebral Ischemia-Reperfusion Injury via Regulation of Apoptosis by Exosomes Derived from BDNF-Overexpressing HEK293, BioMed Research International, 10.1155/2021/6613510, 2021, (1-8), Online publication date: 4-Mar-2021. Minshall C, Ski C, Apputhurai P, Thompson D, Castle D, Jenkins Z and Knowles S (2020) Exploring the Impact of Illness Perceptions, Self-efficacy, Coping Strategies, and Psychological Distress on Quality of Life in a Post-stroke Cohort, Journal of Clinical Psychology in Medical Settings, 10.1007/s10880-020-09700-0, 28:1, (174-180), Online publication date: 1-Mar-2021. Guo Y, Zhou J, Li X, Xiao Y, Zhang J, Yang Y, Feng L and Kang Y (2021) The Association of Suppressed Hypoxia-Inducible Factor-1 Transactivation of Angiogenesis With Defective Recovery From Cerebral Ischemic Injury in Aged Rats, Frontiers in Aging Neuroscience, 10.3389/fnagi.2021.648115, 13 Wang C, Zhang X, Wu Y, Fu L and Fang Q (2021) Clinical Predictors for Functional Independence After Tissue-Window Guided Endovascular Thrombectomy, World Neurosurgery, 10.1016/j.wneu.2020.11.047, 146, (e947-e954), Online publication date: 1-Feb-2021. Maddox T, Januzzi J, Allen L, Breathett K, Butler J, Davis L, Fonarow G, Ibrahim N, Lindenfeld J, Masoudi F, Motiwala S, Oliveros E, Patterson J, Walsh M, Wasserman A, Yancy C and Youmans Q (2021) 2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction, Journal of the American College of Cardiology, 10.1016/j.jacc.2020.11.022, 77:6, (772-810), Online publication date: 1-Feb-2021. Lee S, Ryoo H, Jin S, Ahn J, Sohn S, Hwang Y, Do Y, Lee Y and Kim J (2021) Prehospital Notification Using a Mobile Application Can Improve Regional Stroke Care System in a Metropolitan Area, Journal of Korean Medical Science, 10.3346/jkms.2021.36.e327, 36:48 Parfenov V, Kulesh A, Demin D, Guseva A and Vinogradov O (2021) Vestibular vertigo in stroke and vestibular neuronitis, Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova, 10.17116/jnevro202112112241, 121:12, (41), . Cheng X, Mao S, Zhang Y, Peng X, Ma R, Bao Y, Li Q, Liu M, Sun D, Wan B, Wang L and Zhang F (2021) Early physical rehabilitation vs standard care for intracerebral hemorrhage stroke, Medicine, 10.1097/MD.0000000000024219, 100:3, (e24219) Fang J, Tuo M, Ouyang K and Xu Y (2021) Statin on post-stroke epilepsy: A systematic review and meta-analysis, Journal of Clinical Neuroscience, 10.1016/j.jocn.2020.11.023, 83, (83-87), Online publication date: 1-Jan-2021. Blech B and Demaerschalk B (2021) Telestroke and Teleneurology Telemedicine, Telehealth and Telepresence, 10.1007/978-3-030-56917-4_25, (401-417), . Gao Y, Liu X, Liu K and Xu Y (2021) Middle Cerebral Artery Strokes Encyclopedia of Gerontology and Population Aging, 10.1007/978-3-030-22009-9_1052, (3205-3210), . Darkwah Oppong M, Golubovic J, Hauck E, Wrede K, Sure U and Jabbarli R (2020) Decompressive craniectomy in aneurysmal subarachnoid hemorrhage: Who and when? – A systematic review and meta-analysis, Clinical Neurology and Neurosurgery, 10.1016/j.clineuro.2020.106252, 199, (106252), Online publication date: 1-Dec-2020. Turner A and Faye E (2020) Management of Cervico-Cranial Arterial Dissections, Current Treatment Options in Cardiovascular Medicine, 10.1007/s11936-020-00877-z, 22:12, Online publication date: 1-Dec-2020. Escalard S, Chalumeau V, Escalard C, Redjem H, Delvoye F, Hébert S, Smajda S, Ciccio G, Desilles J, Mazighi M, Blanc R, Maïer B and Piotin M (2020) Early Brain Imaging Shows Increased Severity of Acute Ischemic Strokes With Large Vessel Occlusion in COVID-19 Patients, Stroke, 51:11, (3366-3370), Online publication date: 1-Nov-2020. Carneiro T, Dashkoff J, Leung L, Nobleza C, Marulanda-Londono E, Hathidara M, Koch S, Sur N, Boske A, Voetsch B, Aboul Nour H, Miller D, Daneshmand A, Shulman J, Curiale G, Greer D, Romero J, Anand P and Cervantes-Arslanian A (2020) Intravenous tPA for Acute Ischemic Stroke in Patients with COVID-19, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2020.105201, 29:11, (105201), Online publication date: 1-Nov-2020. Zhong L, Deng W, Zheng W, Yu S, Huang X, Wen Y, Chiu P and Lee C (2020) The relationship between circadian blood pressure variability and maternal/perinatal outcomes in women with preeclampsia with severe features, Hypertension in Pregnancy, 10.1080/10641955.2020.1797777, 39:4, (405-410), Online publication date: 1-Oct-2020. Šiarnik P, Jurík M, Veverka J, Klobučníková K, Kollár B, Turčáni P and Sýkora M (2020) Pulse oximetric routine examination of sleep apnea in acute stroke (PRESS), Sleep Medicine, 10.1016/j.sleep.2020.06.035, 73, (208-212), Online publication date: 1-Sep-2020. Al Khathaami A, Aldriweesh M, Al Bdah B, Alhasson M, Alsaif S, Alluhidan W, Almutairi F, Alskaini M, Alotaibi N and Alghamdi S (2020) Anterior circulation large vessel occlusion stroke in Saudi Arabia: Prevalence, predictors, and outcome, Journal of Stroke and Cerebrovascular Diseases, 10.1016/j.jstrokecerebrovasdis.2020.105080, 29:9, (105080), Online publication date: 1-Sep-2020. Hui W, Wu C, Zhao W, Sun H, Hao J, Liang H, Wang X, Li M, Jadhav A, Han Y and Ji X (2020) Efficacy and Safety of Recanalization Therapy for Acute Ischemic Stroke With Large Vessel Occlusion, Stroke, 51:7, (2026-2035), Online publication date: 1-Jul-2020. Liang F, Zhao Y, Yan X, Wu Y, Li X, Zhou Y, Jian M, Li S, Miao Z, Han R and Peng Y (2020) Choice of ANaesthesia for EndoVAScular treatment of acute ischaemic stroke at posterior circulation (CANVAS II): protocol for an exploratory randomised controlled study, BMJ Open, 10.1136/bmjopen-2019-036358, 10:7, (e036358), Online publication date: 1-Jul-2020. Tucker N, Stoffel J, Hayes L and Jones G (2020) Blood Pressure Management Following Acute Ischemic Stroke, Critical Care Nursing Quarterly, 10.1097/CNQ.0000000000000297, 43:2, (109-121), Online publication date: 1-Apr-2020. Pushko O and Lytvynenko N (2020) MODERN ASPECTS IN THE PARADIGM OF ACUTE HEMISPHERIC ISCHEMIC STROKE: FEATURES OF CLINICAL PRESENTATION, SCREENING, THERAPEUTIC AND NEURO-REHABILITATION PROSPECTS, Bulletin of Problems Biology and Medicine, 10.29254/2077-4214-2020-3-157-30-35, 3:1, (30), . Li R, Li Y, Li B, Sun H, Liu X, Ge X, Liu Y and Yang J (2020) Effectiveness comparisons of different Chinese herbal injection therapies for acute cerebral infarction, Medicine, 10.1097/MD.0000000000021584, 99:32, (e21584) Gao Y, Liu X, Liu K and Xu Y (2020) Middle Cerebral Artery Strokes Encyclopedia of Gerontology and Population Aging, 10.1007/978-3-319-69892-2_1052-1, (1-7), . Related articlesGuidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke AssociationWilliam J. Powers, et al. Stroke. 2019;50:e344-e418 December 2019Vol 50, Issue 12 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.119.027708PMID: 31662117 Originally publishedOctober 30, 2019 KeywordstherapeuticshumansstrokeEditorialssecondary preventionPDF download Advertisement SubjectsIschemic StrokeSecondary Prevention