• Deepak Sharma and Martin Smith.
• Department of Anesthesiology and Pain Medicine and Neurological Surgery, University of Washington, Seattle, Washington, USA.
• Curr Opin Crit Care. 2022 Apr 1; 28 (2): 157165157-165.

Purpose Of ReviewTo discuss recent advances in the critical care management of acute ischaemic stroke patients and highlight controversies and consensus.Recent FindingsIntravenous thrombolysis and endovascular thrombectomy are standard of care reperfusion therapies that have revolutionized the management of acute ischaemic stroke and transformed outcomes for patients. They can now be delivered in extended time windows and to those previously ineligible for intervention based on advanced neuroimaging criteria. Secondary systemic insults, such as hypo- and hypertension, hyperthermia or hyperglycaemia, which can extend the area of ischaemia must also be prevented or corrected to minimize infarct progression. Meticulous blood pressure management is of central importance, particularly in patients that have undergone reperfusion therapies. Neurological deterioration can occur because of infarct extension, haemorrhagic transformation or worsening cerebral oedema. Transcranial Doppler ultrasonography allows bedside, noninvasive evaluation of cerebral haemodynamics and is increasingly used in acute stroke triage, management and recovery prediction. The management of acute ischaemic stroke raises several ethical issues, and shared decision making is essential to ensure outcomes that are compatible with an individual patient's expectations.SummaryA bundle of medical, endovascular and surgical strategies implemented by a multidisciplinary team working to locally agreed protocols can improve long-term stroke outcomes.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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