Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke

OBJECTIVE: This article summarizes the role of thrombolytic therapy, mechanical thrombectomy, and antithrombotic therapy in the early management of acute ischemic stroke. LATEST DEVELOPMENTS: Patient selection and treatment options of acute ischemic stroke are rapidly evolving. Mounting evidence supports the use of IV tenecteplase for acute ischemic stroke. Advanced neuroimaging has helped expand the time window for acute therapies. Recent studies have helped broaden the application of mechanical thrombectomy, particularly for large core infarctions. Our understanding of the best treatment approach to medium and distal vessel occlusions continues to evolve. Early initiation of antithrombotic therapy after ischemic stroke is of paramount importance to reduce the risk of recurrence. ESSENTIAL POINTS: The early management of acute ischemic stroke is complex and requires a sophisticated understanding of the evidence supporting patient selection, use of neuroimaging, and available treatment options.