Acute ischemic stroke (AIS) is a major contributor to death and long-term neurological disability, requiring rapid, evidence-based interventions to maximize neurological recovery. Although mechanical thrombectomy has substantially improved outcomes in patients with large-vessel occlusion, successful reperfusion alone does not fully prevent secondary brain injury or guarantee favorable functional recovery. Consequently, comprehensive hospital protocols integrating acute treatment, neuroprotective measures, and coordinated multidisciplinary rehabilitation have become increasingly important.
Objective: To synthesize the available evidence regarding evidence-based hospital protocols for acute ischemic stroke, focusing on the integration of neuroprotective strategies, mechanical thrombectomy, and multidisciplinary rehabilitation delivered by physicians, physiotherapists, and nurses.
Methods: A systematic review was performed following the PRISMA 2020 statement. Literature searches were conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, SciELO, and the Virtual Health Library (VHL) for studies published between 2013 and 2026. Randomized clinical trials, observational studies, systematic reviews, meta-analyses, and international clinical guidelines addressing acute ischemic stroke management, mechanical thrombectomy, neuroprotection, stroke-unit care, and rehabilitation were considered eligible. Following screening and quality assessment, 75 studies were included in the final analysis.
Results: The evidence consistently supports mechanical thrombectomy as the cornerstone of treatment for eligible patients with large-vessel occlusion, significantly improving reperfusion and functional prognosis. Nevertheless, optimal outcomes depend on the simultaneous implementation of standardized neuroprotective interventions, including strict control of physiological parameters such as blood pressure, glycemia, oxygenation, and body temperature. The reviewed studies also demonstrated that organized Stroke Unit care and coordinated multidisciplinary management reduce neurological deterioration, medical complications, length of hospitalization, and disability. Early rehabilitation, respiratory physiotherapy, progressive mobilization, swallowing assessment, and continuous nursing care were identified as key elements for improving functional recovery and patient independence.
Conclusions: Contemporary hospital management of acute ischemic stroke should combine rapid reperfusion therapies with evidence-based neuroprotective practices and structured multidisciplinary rehabilitation. This integrated approach enhances preservation of viable brain tissue, minimizes secondary injury, improves neurological and functional outcomes, and reinforces the importance of comprehensive Stroke Unit protocols as the current standard of care while supporting the development of emerging neuroprotective therapies.