The Management of Acute Ischaemic Stroke – A Review and South African Perspective

Abstract

Reperfusion therapy in acute ischaemic stroke, namely intravenous thrombolysis and mechanical thrombectomy, have traditionally had strict time-based eligibility criteria. Recent advances in diagnostic and imaging modalities have resulted in a more dynamic view of eligibility for these therapies. The time clock concept may soon be superseded by the “tissue clock” concept, where accurate identification of the extent of the salvageable penumbra has been shown to result in favourable outcomes well beyond the traditional time limits in carefully selected patients. However in a low-middle income country like South Africa, the social, economic and geographic barriers to an effective acute stroke management service are often overwhelming. In this review we provide an update on the current evidence guiding management of acute ischaemic stroke, with a particular emphasis on the challenges faced in resource-constrained regions.