Algorithm
- Time is brain: note last known well; activate stroke pathway; ABC, glucose, BP.
- Non-contrast CT head urgently — exclude hemorrhage before thrombolysis.
- IV alteplase within 4.5 h if ischemic stroke and no contraindications.
- Mechanical thrombectomy for large vessel occlusion within extended window per imaging.
- BP management: avoid aggressive lowering pre-thrombolysis unless >185/110 mmHg.
- Admit stroke unit; swallow screen before oral intake.
Red flags
- • Airway compromise or GCS drop
- • Seizure / hypoglycemia mimicking stroke — correct glucose first
- • Outside thrombolysis/thrombectomy window — still urgent stroke pathway
Medications by step
Step 1 — Thrombolysis
- Alteplase (rtPA) · i.v.
0.9 mg/kg (max 90 mg); 10% bolus, rest over 60 min
Step 2 — Antiplatelet (post-hemorrhage excluded)
- Aspirin · p.o.
300 mg PO after 24 h if thrombolysis given
Step 3 — BP control
- Labetalol · i.v.
10–20 mg IV; titrate to target <185/110 pre-lysis
References
- • ESO Guidelines — Acute ischemic stroke (2023)
Updated: Июль 2026