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Treatment of Acute Ischemic Stroke 243

mains to be proven.
The evolution of emergency treatment for acute
ST-segment elevation myocardial infarction can in-
form the future of acute stroke therapy from a prox-
imal artery occlusion Fibrinolysis followed by endo-
vascular therapy was initially a common practice but
was later abandoned after randomized trials demon-
strated that proceeding directly to the endovascular
intervention was a superior strategy. Once systems
of care are optimized to guarantee fast access to the
angiographic suite for patients with acute stroke it
will be necessary to perform a trial comparing IV
thrombolysis followed by mechanical thrombectomy
for patients with server stroke and proven proximal
artery occlusion.

Conclusion
Acute ischemic stroke is a medical emergency in
which every minute counts. Achievement of reper-
fusion can reverse neurologic deficits even if severe,
and allow patients to regain function. Two reperfusion
strategies are now proven IV rtPA and mechanical
thrombectomy. They are both safe and effective for
the right candidates. Patient selection is crucial to
optimize outcomes but the attitude of the clinician
should be that treatment should be given unless a
solid contra indication exists.

At this juncture efforts should be concentrated on re-
fining systems of care to allow more patients to have
access to reperfusion treatment expanding the num-
ber of candidates for intervention will require contin-
uous education of the community to recognize signs
of stroke, improving the initial triage of patients with
stroke and speeding evaluation and treatment in the
hospital. Ongoing trials are also evaluating the pos-
sibility of extending the therapeutic window by using
advanced imaging modalities to identify patients in
whom good collaterals have preserved tissue viability
for a longer time. Collateral augmentation strategies
and ultra- early administration of neuroprotective
agents may provide additional treatment venues in
the future.

Cardio Diabetes Medicine