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Early management of acute cerebrovascular accident

Purpose of review Stroke is common and often presents as a neurologic emergency that requires rapid evaluation and treatment to minimize debilitation. Recent advances in therapy expanded time windows for intra-arterial thrombectomy in ischemic stroke, and surgical interventions for clot evacuation in large intracranial hemorrhage have recently proven feasible. This review discusses recent data regarding new therapeutic options in both ischemic and hemorrhagic stroke, notably in scenarios in which therapy was previously limited to supportive care. Recent findings Recent data show that intra-arterial therapy in ischemic stroke provides both benefit in outcomes and potential for further advancements in care. Therapeutic windows for endovascular treatment of a cerebral vessel occlusion now extend to 6 h, and recent data suggest this may increase further to 24 h. Intervention in hemorrhagic stroke remains limited to reversal of coagulopathy and hypertension; however, surgical techniques are underway and may prove beneficial in some cases. Summary Advancing therapeutics in ischemic and hemorrhagic stroke are changing acute care intervention and broadening potential candidates for what were once thought to be nonintervenable conditions. Execution of best practices in stroke will continue to evolve and will require understanding advanced imaging techniques, as well as selection criteria for procedural and surgical interventions.