Patient handout

Acute Ischaemic Stroke

PRODUCTION

1. Your condition

This handout is for acute ischaemic stroke. Your care team identified this based on: sudden focal neurological deficit (fast/befast; aha/asa 2019).

Other reasons your team may use this plan: aphasia / dysarthria of sudden onset (aha/asa 2019); hemiparesis / facial droop (aha/asa 2019); large-vessel occlusion on cta (aha/asa 2019 class i).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
alteplase	0.9 mg/kg IV (max 90 mg); 10% as bolus over 1 min, remaining 90% as infusion over 60 min	IV	single course	NINDS / ECASS-III — thrombolysis ≤4.5h reduces disability
tenecteplase	0.25 mg/kg IV single bolus over 5 sec (max 25 mg)	IV	single bolus	AcT (Lancet 2022) — TNK 0.25 mg/kg non-inferior to alteplase; preferred per 2026 AHA/ASA

Plan: Acute reperfusion (IV thrombolysis ± EVT) + BP control + early antiplatelet (AHA/ASA 2019)

3. When to call your provider

Contact your care team if any of the following happen:

Any new TIA-spectrum or stroke-like event → ED (AHA/ASA 2021)
BP persistently >140/90 despite 3-drug regimen → resistant HTN workup (cardio.htn.resistant.v1; 2025 AHA/ACC HTN)
PHQ-9 ≥15 OR suicidal ideation → urgent psych referral (AHA/ASA 2021)
MoCA <26 OR cognitive decline noted by family → neurocognitive workup; consider donepezil per AHA/ASA 2021
Statin intolerance → ezetimibe + PCSK9i if LDL >55 (2026 ACC/AHA Lipid)
DOAC bleeding event → temporary hold, reversal if life-threatening (idarucizumab / andexanet), reassess net benefit

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

LVO on CTA + within 24 h LKW + ASPECTS ≥6 OR imaging mismatch (AHA/ASA 2019 Class I)
Basilar artery occlusion — any NIHSS (ATTENTION 2022; BAOCHE 2022)(life-threatening)
New severe headache, HTN, N/V, or NIHSS decline ≥4 within 24 h post-tPA (AHA/ASA 2019)(life-threatening)
NIHSS ≥15, infarct >50% MCA territory on imaging, age <60, decline within 48 h (DESTINY II, Jüttler NEJM 2014)(life-threatening)
NIHSS increase ≥4 points within 24 h regardless of pre-existing therapy (AHA/ASA 2019 Class I)
TOAST class: large-artery atherosclerosis — carotid stenosis ≥50% ipsilateral on CTA/MRA/duplex OR intracranial atherosclerosis on vessel wall MRI
TOAST class: cardioembolic — AF on telemetry/ECG; LV thrombus on TTE; mechanical valve; large embolic-pattern infarct (cortical or multi-territory)
TOAST class: other-determined etiology — vessel-wall MRI dissection sign; antiphospholipid antibodies positive; hypercoag panel positive (protein C/S, antithrombin, factor V Leiden); CNS vasculitis on DSA

5. Follow-up

Secondary prevention: high-intensity statin LDL <55 (2026 ACC/AHA Lipid), BP <130/80 (2025 AHA/ACC HTN), DAPT/anticoag per source, dysphagia/SLP, rehab, AF screen

6. Sources

Guideline: 2026 AHA/ASA Guideline for the Early Management of Patients With Acute Ischemic Stroke (Stroke 2026; DOI 10.1161/STR.0000000000000513) + 2024 AHA/ASA Primary Prevention + 2024 ESC AF + 2025 AHA/ACC HTN + 2026 ACC/AHA Dyslipidemia