The management of ischaemic stroke

Ischaemic stroke often leads devastating long-term neurological sequelae. There are five interventions that improve the outcome after a stroke: management within a stroke unit, intravenous thrombolysis, mechanical clot retrieval, aspirin within 48 hours, and decompressive hemicraniectomy for malignant middle cerebral artery (MCA) stroke. The benefits of intravenous thrombolysis up to 4.5 hours are now well established, but the recent development of clot retrieval has radically altered the acute management of stroke. The development of late complications remains the most important factor determining outcome and it is essential to ensure homoeostasis is maintained during the acute phase of care to reduce the risk of late deterioration.