Update on the management of acute stroke. A practical clinical guide

The diagnosis and treatment of acute ischemic stroke (AIS) have undergone great changes in the past few decades. The keys to a correct selection of the best therapeutic modality are an early identification of patients with AIS symptoms, the correct interpretation of the different neuroimaging techniques, and, if possible, to provide a reperfusion therapy as soon as possible. This review will analyze the principles of each of the new neuroimaging techniques for A1S, how these new techniques can help in clinical practice, the different treatment options, as well as the inclusion and exclusion criteria for each of them. A systematic research was conducted on MEDLINE (PubMed), using the following Medical Subject Headings terms: (AIS) + (neuroimaging/techniques) + (thrombolytic therapy) + (mechanical thrombectomy). We selected original articles, as well as clinical trials and review articles. Each article was read to completion, to check for other useful references. We also reviewed the different therapeutic options for AIS, including endovascular approaches through a selection of the most recent neuroimaging techniques. In conclusion, intravenous thrombolysis continues to be the cornerstone for the treatment of AIS. The attending physician has a fundamental role in suspecting and confirming large vessel occlusions, and in deciding which is the most appropriate therapeutic option for each case, with important prognostic implications for the patient.