MANAGEMENT OF ISCHEMIC STROKE IN THE EMERGENCY DEPARTMENT: A LITERATURE REVIEW

• DOI: https://doi.org/10.22533/at.ed.01596426200313

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• Abstract:

  
  Introduction: Stroke is an acute neurological condition resulting from changes in cerebral blood flow and can be classified as ischemic or hemorrhagic. It is one of the leading causes of morbidity and mortality worldwide and is associated with several modifiable risk factors. Early recognition of signs and symptoms is essential for rapid therapeutic decision-making, as the time to treatment directly impacts prognosis. In this context, interventions such as intravenous thrombolysis and mechanical thrombectomy play a central role in the management of ischemic stroke, especially when performed within the appropriate therapeutic windows. Method: This study is a narrative review of the literature, conducted through a search of the Virtual Health Library (VHL) and PubMed databases. The search terms “management,” “stroke,” and “ischemic” were used. As inclusion criteria, articles published in English and Portuguese in 2025, available in full and free of charge, were selected. Studies with unclear methodology, non-scientific publications, and articles outside the scope of the topic were excluded. After applying the criteria, seven articles were selected for data analysis and synthesis. Results and Discussion: The analyzed evidence demonstrates that reperfusion therapy remains the cornerstone of treatment for acute ischemic stroke, with a focus on intravenous thrombolysis and mechanical thrombectomy. Recent studies indicate an expansion of the indications for these therapies, based on clinical and imaging criteria. In posterior cerebral artery occlusions, endovascular therapy has shown potential functional benefit and reduced mortality, although stronger evidence is still needed. On the other hand, in medium-sized vessel occlusions, there is no consistent benefit from endovascular intervention, and caution is recommended. In cases of mild stroke, e l thrombolysis should be indicated on an individualized basis, prioritizing disabling deficits. Furthermore, low adherence to dual antiplatelet therapy was observed in clinical practice, despite its efficacy in preventing recurrence. Finally, modifiable risk factors, especially hypertension, remain the main determinants of stroke mortality. Conclusion: Appropriate management of ischemic stroke depends on a rapid, individualized, and evidence-based approach. Early recognition, correct patient selection, and timely application of reperfusion therapies are fundamental for better outcomes. Furthermore, adherence to treatment protocols and the management of modifiable risk factors play a key role in reducing mortality and sequelae, underscoring the importance of integrated strategies that encompass care, prevention, and the organization of health systems.