ICU · Neurocritical care / vascular

Acute Ischaemic Stroke — Thrombolysis, Thrombectomy & Hemicraniectomy

Also known as Acute ischaemic stroke · AIS · Thrombolysis · Alteplase · Tenecteplase · Mechanical thrombectomy · Large-vessel occlusion · LVO · DAWN trial · DEFUSE-3 trial · Decompressive hemicraniectomy · Malignant MCA infarct · NIHSS · ASPECTS · Haemorrhagic transformation

Acute ischaemic stroke is managed within strict time windows. The IV thrombolysis (alteplase 0.9 mg/kg, max 90 mg; within 4.5 hours of the onset) is for any measurable stroke without contraindications. The mechanical thrombectomy (within 6 hours for the large-vessel occlusion — the ICA, the M1 MCA, the basilar; extended to 24 hours for the selected patients with the CT perfusion mismatch per the DAWN and DEFUSE-3 trials) recanalises the large vessel directly. The post-stroke ICU care: the BP control (permissive hypertension below 220/120 for the non-thrombolysed; under 185/110 before and 180/105 for 24 hours after the thrombolysis), the aspirin after 24 hours, the statin, the swallow assessment, and the DVT prophylaxis. The decompressive hemicraniectomy (within 48 hours, for the patients under 60) for the malignant MCA infarct — the DESTINY, DECIMAL, and HAMLET trials showed an improved survival and a functional outcome.

Checked against its sources on 3 Sept 2026