Abstract
In acute stroke, rapid administration of intravenous recombinant tissue-type plasminogen activator (r-tPA) to stroke patients is the mainstay of treatment. Intravenous r-tPA improves functional outcomes when given within 4.5 h of ischemic stroke onset. Patients eligible for intravenous r-tPA should receive intravenous r-tPA even if endovascular treatments are being considered. Patients should receive endovascular therapy with a stent retriever if they meet appropriate criteria as per the American Heart Association guidelines. With the publication of results of the carotid revascularization endarterectomy versus stenting trial (CREST), there is evidence of no difference in the rate of late ipsilateral stroke after endarterectomy or stenting at 4 and 10 years. CREST provides the physician more options for the treatment of carotid stenosis and has shown that both carotid endarterectomy and carotid artery stenting are effective and safe when performed by experienced operators, and when patients are chosen appropriately.
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