ÎÎAt present, no pharmacologic agents with putative neuroprotective
actions have demonstrated efficacy in improving outcomes after
ischemic stroke, and therefore, other neuroprotective agents are NOT
recommended (III-A).
ÎÎWith the exception of stroke secondary to air embolization, hyperbaric
oxygen is NOT recommended for treatment of patients with acute
ischemic stroke (III-B).
Note: Data on the utility of hyperbaric oxygen are inconclusive, and some data imply
that the intervention may be harmful.
Surgical Interventions
ÎÎThe usefulness of emergent or urgent carotid endarterectomy is not
well established when:
• clinical indicators or brain imaging suggests a small infarct core with a large
territory at risk (eg, penumbra)
• circulation is compromised by inadequate flow from a critical carotid stenosis or
occlusion
• acute neurological deficit after carotid endarterectomy may be caused by
thrombosis of the surgical site (IIb-B).
ÎÎIn patients with unstable neurological status (either stroke-inevolution or crescendo TIA), the efficacy of emergent or urgent carotid
endarterectomy is not well established (IIb-B).
Admission to the Hospital and General Acute Treatment
(After Hospitalization)
ÎÎUse comprehensive specialized stroke care (stroke units) that
incorporates rehabilitation (I-A).
ÎÎTreat patients with suspected pneumonia or urinary tract infections
with appropriate antibiotics (I-A).
ÎAdminister subcutaneous anticoagulants for treatment of immobilized
Î
patients to prevent deep vein thrombosis (I-A).
ÎÎUse standardized stroke care order sets to improve general
management (I-B).
ÎÎAssess swallowing before the patient begins eating, drinking, or
receiving oral medications (I-B).
ÎÎPatients who cannot take solid food and liquids orally should receive
nasogastric, nasoduodenal, or percutaneous endoscopic gastrostomy
tube feedings to maintain hydration and nutrition while undergoing
efforts to restore swallowing (I-B).
ÎÎMobilize less severely affected patients early and take measures to
prevent subacute complications of stroke (I-C).
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