3 Key Takeaways
Plain English Summary- 01Core Finding
Common presentations include sudden arm or leg weakness, aphasia or slurred speech, sudden loss of balance or coordination, sudden visual difficulties, and/or facial drooping.
- 02Study Evidence
Tested in a randomized controlled trial at the randomized clinical trial stage.
- 03Practical Meaning
Controlled trial findings show causal benefit under protocol rules; real-world effectiveness can vary across patients.
What This Means for You
Acute ischemic stroke causes substantial disability and mortality. First-line therapy for patients with disabling acute stroke symptoms is intravenous thrombolysis (if no contraindications) within 4.5 hours of stroke onset and up to 24 hours in carefully selected patients not receiving mechanical thrombectomy; for large vessel occlusions, mechanical thrombectomy may be performed up to 24 hours after stroke onset in eligible patients.
The Discovery
Acute ischemic stroke, caused by thrombotic or embolic occlusion of a cervical or cerebral artery, leads to neurologic injury due to sudden disruption of blood flow to the brain. Ischemic stroke is a leading cause of disability and death and accounts for substantially of strokes in the US. Symptoms of acute ischemic stroke vary based on the area of the affected brain. Common presentations include sudden arm or leg weakness, aphasia or slurred speech, sudden loss of balance or coordination, sudden visual difficulties, and/or facial drooping. Patients with suspected stroke should be transported to the nearest emergency department for urgent brain imaging, typically noncontrast computed tomography (CT). Based on 2026 American Heart Association/American Stroke Association (AHA/ASA) guidelines, first-line therapy for patients with acute ischemic stroke presenting within 4.5 hours from symptom onset with disabling symptoms (eg, affecting the ability to perform activities of daily living) is intravenous thrombolysis (tenecteplase or alteplase) in those without intracranial hemorrhage or other contraindications to thrombolysis. The treatment window can be extended to 9 hours-and up to 24 hours in patients with large vessel occlusion (eg, involving the internal carotid artery or proximal middle cerebral artery [M1 segment]) who are unable to receive thrombectomy-based on identification of salvageable tissue using perfusion imaging with CT perfusion or magnetic resonance imaging. In appropriately selected patients with acute ischemic stroke, pooled randomized trial data show an approximately 10% absolute increase in the probability of a better functional outcome with intravenous thrombolysis.
How It Works, Simply
This cardiology research focuses on cardiovascular hemodynamic & lipid pathway modulation. Researchers evaluated it using a randomized controlled trial at the randomized clinical trial stage of medical research.
3 Key Takeaways
Clinical Takeaways- 01Core Finding
Common presentations include sudden arm or leg weakness, aphasia or slurred speech, sudden loss of balance or coordination, sudden visual difficulties, and/or facial drooping.
- 02Study Evidence
Tested in a randomized controlled trial at the randomized clinical trial stage.
- 03Practical Meaning
Controlled trial findings show causal benefit under protocol rules; real-world effectiveness can vary across patients.
Key Numbers
Biological Mechanism & Study Design
Study Design & Cohort
Randomized controlled trial
Randomized controlled trial · Randomized Clinical Trial
Biological Pathway & Modality
Cardiovascular hemodynamic & lipid pathway modulation
Intervention: Treatment of Acute Ischemic Stroke: A Review
Experimental Findings & Endpoints
Acute ischemic stroke, caused by thrombotic or embolic occlusion of a cervical or cerebral artery, leads to neurologic injury due to sudden disruption of blood flow to the brain.
Ischemic stroke is a leading cause of disability and death and accounts for substantially of strokes in the US. Symptoms of acute ischemic stroke vary based on the area of the affected brain.
Common presentations include sudden arm or leg weakness, aphasia or slurred speech, sudden loss of balance or coordination, sudden visual difficulties, and/or facial drooping. Patients with suspected stroke should be transported to the nearest emergency department for urgent brain imaging, typically noncontrast computed tomography (CT).
Based on 2026 American Heart Association/American Stroke Association (AHA/ASA) guidelines, first-line therapy for patients with acute ischemic stroke presenting within 4.5 hours from symptom onset with disabling symptoms (eg, affecting the ability to perform activities of daily living) is intravenous thrombolysis (tenecteplase or alteplase) in those without intracranial hemorrhage or other contraindications to thrombolysis. The treatment window can be extended to 9 hours-and up to 24 hours in patients with large vessel occlusion (eg, involving the internal carotid artery or proximal middle cerebral artery [M1 segment]) who are unable to receive thrombectomy-based on identification of salvageable tissue using perfusion imaging with CT perfusion or magnetic resonance imaging.
In appropriately selected patients with acute ischemic stroke, pooled randomized trial data show an approximately 10% absolute increase in the probability of a better functional outcome with intravenous thrombolysis.
Clinical Translation & Practice Context
Acute ischemic stroke causes substantial disability and mortality.
First-line therapy for patients with disabling acute stroke symptoms is intravenous thrombolysis (if no contraindications) within 4.5 hours of stroke onset and up to 24 hours in carefully selected patients not receiving mechanical thrombectomy; for large vessel occlusions, mechanical thrombectomy may be performed up to 24 hours after stroke onset in eligible patients.
The Bottom Line · Clinical Pearl
“Acute ischemic stroke causes substantial disability and mortality.”
Published in JAMA · Current Stage: Randomized Clinical Trial
