The ESC Textbook of Cardiovascular Medicine (3 edn)
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Stroke is caused by a clot blocking a cerebral artery and leading to ischaemic damage or by haemorrhage destroying cerebral tissue. The goal of stroke treatment is recanalization of the blocked cerebral artery and reperfusion in order to salvage the tissue jeopardized by ischaemia. Clots blocking the internal carotid T or the main stem of the middle cerebral artery are large and usually cause moderate to severe neurological deficits. They can be removed quickly and safely with mechanical thrombectomy, with or without prior thrombolytics. Clots blocking peripheral branches are smaller, usually associated with minor or moderate neurological deficits, and can be dissolved with recombinant tissue plasminogen activator. Clots blocking the basilar artery can be treated with recombinant tissue plasminogen activator or removed mechanically, but there is equipoise regarding what approach results in better clinical outcomes. Treatment of acute cerebral haemorrhage is limited to blood pressure lowering when elevated, normalization of coagulation when abnormal, and surgery in selected patients. Stroke treatment is time critical. Time is brain, and therefore stroke is an emergency. Stroke treatment requires teamwork in stroke units or centres and should best be organized in regional stroke networks.
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