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Abstract：
BACKGROUND: Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies.
METHODS: Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible.
CONCLUSIONS: Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated.
METHODS: Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 °C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible.
CONCLUSIONS: Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intra-arterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated.
摘要：
背景：在对文献进行严格回顾的基础上，更新西班牙神经学会的急性缺血性卒中治疗指南。建议是根据已发表数据和研究的证据水平提出的。
方法：应实施有组织的护理系统，以确保在卒中单元中对所有急性卒中患者进行最佳管理。护理标准应包括血压的治疗（仅当血压值超过185/105mmHg时才应治疗），治疗高血糖超过155毫克/分升，如果体温超过37.5℃，则用解热药物治疗体温。必须预防和及时治疗神经系统并发症。在恶性脑水肿的情况下，应考虑去减压化半切除术。rtPA静脉溶栓应在症状发作后4.5小时内进行。除非有禁忌症.动脉内药物溶栓可在6小时内考虑，在发病后8小时内进行机械血栓切除，前循环中风，而对于后发中风，长达12-24小时的更宽的机会窗口是可行的。没有足够的证据推荐常规使用所谓的神经保护药物。对脑静脉血栓形成患者应给予抗凝治疗。康复应该尽早开始。
结论：急性缺血性卒中的治疗包括卒中单元患者的治疗。应在症状发作后4.5小时内考虑全身溶栓。在某些情况下，具有更宽机会窗口的动脉内方法可能是一种选择。正在研究保护性和恢复性疗法。
方法：应实施有组织的护理系统，以确保在卒中单元中对所有急性卒中患者进行最佳管理。护理标准应包括血压的治疗（仅当血压值超过185/105mmHg时才应治疗），治疗高血糖超过155毫克/分升，如果体温超过37.5℃，则用解热药物治疗体温。必须预防和及时治疗神经系统并发症。在恶性脑水肿的情况下，应考虑去减压化半切除术。rtPA静脉溶栓应在症状发作后4.5小时内进行。除非有禁忌症.动脉内药物溶栓可在6小时内考虑，在发病后8小时内进行机械血栓切除，前循环中风，而对于后发中风，长达12-24小时的更宽的机会窗口是可行的。没有足够的证据推荐常规使用所谓的神经保护药物。对脑静脉血栓形成患者应给予抗凝治疗。康复应该尽早开始。
结论：急性缺血性卒中的治疗包括卒中单元患者的治疗。应在症状发作后4.5小时内考虑全身溶栓。在某些情况下，具有更宽机会窗口的动脉内方法可能是一种选择。正在研究保护性和恢复性疗法。
