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AHA/ASA Early Management of Acute Ischemic Stroke 2026

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48 General Supportive Early Management 4.10. Volume Expansion/Hemodilution, Vasodilators, and Hemodynamic Augmentation COR LOE Recommendations 3: No benefit A 1. In patients with AIS, hemodynamic augmentation using hemodilution, high-dose albumin, or chemical vasodilators such as pentoxifylline is not recommended to improve functional clinical outcomes. 3: No benefit B-R 2. In patients with AIS, mechanical hemodynamic augmentation with counterpulsation devices or sphenopalatine ganglion stimulation is not recommended to improve functional clinical outcomes. 4.11. Neuroprotective Agents COR LOE Recommendation 3: No benefit A 1. At present, in patients with AIS, the use of pharmacological or nonpharmacological neuroprotective treatments is not recommended to improve functional outcome. 4.12. Emergency Carotid Endarterectomy, Carotid Angioplasty, and Stenting Without Intracranial Clot COR LOE Recommendation 3: No benefit B-NR 1. In patients with AIS or unstable neurological status (eg, stroke in evolution) caused by a high-grade carotid stenosis or occlusion without intracranial occlusion, emergent carotid endarterectomy (within 48 hours) is not beneficial to improve functional outcomes

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