IMPROVING THE MANAGEMENT STRATEGY FOR PATIENTS WITH ACUTE ISCHEMIC STROKE DURING THE THERAPEUTIC WINDOW: A REVIEW OF CURRENT REPERFUSION APPROACHES

Abstract

Background. Acute ischemic stroke (AIS) is a major neurological emergency and one of the leading causes of death and long-term disability worldwide. The effectiveness of reperfusion therapy is strongly dependent on the time from symptom onset to treatment. However, recent advances in neuroimaging and endovascular treatment have demonstrated that the biological status of ischemic brain tissue may be more important than chronological time alone in selected patients.

Objective. To review current approaches to the management of patients with acute ischemic stroke during the therapeutic window and to identify strategies for optimizing reperfusion therapy, patient selection, and functional outcomes.

Materials and Methods. A narrative literature review was conducted based on contemporary international clinical guidelines, randomized controlled trials, systematic reviews, and meta-analyses published predominantly between 2020 and 2026. The review focused on intravenous thrombolysis, alteplase, tenecteplase, mechanical thrombectomy, bridging therapy, multimodal neuroimaging, extended therapeutic windows, and tissue-based patient selection.

Results. Current evidence supports rapid intravenous thrombolysis in eligible patients with disabling acute ischemic stroke within

4.5 hours of symptom onset or last known well. Tenecteplase at a dose of 0.25 mg/kg has demonstrated non-inferior functional outcomes compared with alteplase at 0.9 mg/kg in contemporary randomized clinical trials and provides the practical advantage of single-bolus administration. Mechanical thrombectomy is a highly effective treatment for selected patients with large-vessel occlusion and is recommended within 6 hours in appropriate patients and up to 24 hours in selected patients based on clinical and imaging criteria. Computed tomography angiography and computed tomography perfusion facilitate identification of vascular occlusion, infarct core, and potentially salvageable tissue.

Conclusion. Optimization of acute ischemic stroke management during the therapeutic window requires a coordinated, time-sensitive, and individualized approach. Rapid recognition, immediate neuroimaging, early reperfusion, identification of large-vessel occlusion, appropriate use of intravenous thrombolysis and mechanical thrombectomy, and tissue-based patient selection represent the major components of contemporary stroke care.