An optimised prehospital management is important for acute stroke patients. A structured admittance to a stroke centre increases the rate of thrombolysis four-fold. To achieve short door-to-needle-times (< 30 min) a multi-disciplinary approach is necessary. Elderly stroke patients benefit from stroke unit therapy as do the younger patients. Blood pressure management is important during the first 24 hours after thrombolysis. Systolic blood pressures between 140 - 150 mmHg correlate with low bleeding rates. A subgroup analysis of the ECASS III study shows that a broad range of patients can be treated safely and efficiently in the 3 - 4.5 hour time window. Endovascular recanalisation therapy achieves high recanalisation rates. Whether these will be responsible for a significantly better outcome has to be shown in future randomised trials.
© Georg Thieme Verlag KG Stuttgart · New York.