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For additional information about the management of acute ischemic stroke, see the American Heart Association (AHA)/American Stroke Association (ASA) guidelines for the management of acute ischemic stroke.

The overall goal of stroke care is to minimize acute brain injury and maximize patient recovery.

This chapter summarizes the early management of acute ischemic stroke in adult patients.

It describes care from out-of-hospital therapy through the first hours of in-hospital therapy.

The AHA ECC stroke guidelines focus on the initial out-of-hospital and ED assessment and management of the patient with acute stroke as depicted in the algorithm Goals for Management of Patients With Suspected Stroke (Figure).

The time goals of the National Institute of Neurological Disorders and Stroke (NINDS) are illustrated on the left side of the algorithm as clocks.

Identifying clinical signs of possible stroke is important because recanalization strategies (intravenous [IV] fibrinolysis and intra-arterial/catheter-based approaches) must be provided within the first few hours from onset of symptoms.

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The time-sensitive nature of stroke requires such an approach, even in densely populated metropolitan centers.The text refers to the numbered boxes in the algorithm.