Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.

In 1991, about 500 000 Americans had a stroke (400 000 had an ischemic stroke) and more than 143 000 died.' More than 3 000 000 people in the United States have survived a stroke. In 1994 the annual economic costs of stroke due to health care expenses and lost productivity are estimated to be nearly $20 billion.' In spite of these human and financial costs, stroke unfortunately has not received a great deal of attention, and its management has been marred by an element of nihilism.2 Caplan3 concludes that past failures to establish effective therapies for stroke are due to problems in clinical trial design, lack of interest in care of stroke, and lack of available technologies to evaluate patients. However, with advances in diagnosis and treatment, stroke can now be managed as the life-threatening emergency that it is. In 1993 the American Heart Association included emergent stroke care as part of its special resuscitation situations for basic and advanced life support.4 This report builds on that statement. The goal of this special report is to provide information about the current management of acute ischemic stroke. It also provides recommendations for initial care (within 24 hours of stroke) based on currently available data from clinical trials. In the future, many therapies for stroke will be linked to very early (within 6 hours) intervention. No recommendations about rehabilitation or chronic medical or surgical measures to prevent recurrent stroke are made. To prepare this report, the members of the Stroke Council used the rules of evidence for specific treatments that have been used by other panels (Table 1).5 These rules give greater credence to the results of well-designed clinical trials than to anecdotal case reports or case series. The current recommendations will eventually be altered