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(Circulation. 2007;115:e478-e534.)
© 2007 American Heart Association, Inc.

AHA/ASA Guideline

Guidelines for the Early Management of Adults With Ischemic Stroke

A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.

Harold P. Adams, Jr, MD, FAHA, Chair; Gregory del Zoppo, MD, FAHA, Vice Chair; Mark J. Alberts, MD, FAHA; Deepak L. Bhatt, MD; Lawrence Brass, MD, FAHA; Anthony Furlan, MD, FAHA; Robert L. Grubb, MD, FAHA; Randall T. Higashida, MD, FAHA; Edward C. Jauch, MD, FAHA; Chelsea Kidwell, MD, FAHA; Patrick D. Lyden, MD; Lewis B. Morgenstern, MD, FAHA; Adnan I. Qureshi, MD, FAHA; Robert H. Rosenwasser, MD, FAHA; Phillip A. Scott, MD, FAHA; Eelco F.M. Wijdicks, MD, FAHA

Purpose— Our goal is to provide an overview of the current evidence about components of the evaluation and treatment of adults with acute ischemic stroke. The intended audience is physicians and other emergency healthcare providers who treat patients within the first 48 hours after stroke. In addition, information for healthcare policy makers is included.

Methods— Members of the panel were appointed by the American Heart Association Stroke Council’s Scientific Statement Oversight Committee and represented different areas of expertise. The panel reviewed the relevant literature with an emphasis on reports published since 2003 and used the American Heart Association Stroke Council’s Levels of Evidence grading algorithm to rate the evidence and to make recommendations. After approval of the statement by the panel, it underwent peer review and approval by the American Heart Association Science Advisory and Coordinating Committee. It is intended that this guideline be fully updated in 3 years.

Results— Management of patients with acute ischemic stroke remains multifaceted and includes several aspects of care that have not been tested in clinical trials. This statement includes recommendations for management from the first contact by emergency medical services personnel through initial admission to the hospital. Intravenous administration of recombinant tissue plasminogen activator remains the most beneficial proven intervention for emergency treatment of stroke. Several interventions, including intra-arterial administration of thrombolytic agents and mechanical interventions, show promise. Because many of the recommendations are based on limited data, additional research on treatment of acute ischemic stroke is needed.

Key Words: AHA Scientific Statements • emergency medical services • stroke • acute cerebral infarction • tissue plasminogen activator

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