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Neuroprotective Agents
Î Among patients already taking statins at the time of onset of ischemic
stroke, continuation of statin therapy during the acute period is
reasonable (IIa-B).
Î The utility of induced hypothermia for the treatment of patients with
ischemic stroke is not well established (IIb-B).
Note: Further trials are recommended.
Î At present, transcranial near-infrared laser therapy is not well
established for the treatment of acute ischemic stroke (IIb-B).
Note: Further trials are recommended.
Î At 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).
Î With 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
Î The 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).
Î In patients with unstable neurological status (either stroke-in-
evolution 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)
Î Use comprehensive specialized stroke care (stroke units) that
incorporates rehabilitation (I-A).
Î Treat patients with suspected pneumonia or urinary tract infections
with appropriate antibiotics (I-A).
ÎAdminister subcutaneous anticoagulants for treatment of immobilized
patients to prevent deep vein thrombosis (I-A).
