What is the first-line treatment in acute ischemic stroke within the recommended time frame?

Fibrinolytic therapy is the first-line treatment for acute ischemic stroke within the recommended time frame, which is typically within 4.5 hours of symptom onset. This treatment aims to dissolve the clot that is obstructing blood flow to the brain, thus helping to restore perfusion to the affected area and minimize neurological damage. The most commonly used agent for this purpose is tissue plasminogen activator (tPA). Prompt administration of fibrinolytics can significantly improve patient outcomes, as it can reduce morbidity and mortality associated with ischemic strokes.

While endovascular therapy is also an important treatment option, especially for certain patients with large vessel occlusion, it is generally considered as a second-line treatment that is performed under specific conditions and is often used alongside fibrinolytic therapy rather than as the initial approach. Antiplatelet therapy is mainly used for secondary prevention of stroke rather than acute treatment, and neuroprotective agents, while they may have potential in stroke management, are not currently established as first-line treatments within the acute phase. Thus, fibrinolytic therapy stands out as the initial and most effective treatment for acute ischemic stroke in the critical early hours following symptom onset.