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The spectacular recent trials of urgent neurointervention for acute stroke: fuel for a revolution

How should we redesign our stroke services in light of neurointerventional advances?

In 2013, neutral results from three trials of neurointervention for treating ischaemic stroke were simultaneously published — a triad of gloom.13 In just over 2 years since, five positive trials have been reported.48 What explains this extraordinary turnaround, and what are the implications for stroke services in Australia and around the world? The answers to these questions are surprising and reflect a mixture of science, technology and policy.

The roles of science, technology and policy

The science involved is the culmination of a decade of work on proving that brain imaging can identify the ischaemic penumbra — the area of the brain that has shut down and is on the path to infarction but, with successful reperfusion, is potentially salvageable. By recruiting patients with a favourable profile for reperfusion therapy (so-called target mismatch, where the ratio of perfusion lesion to established infarct is > 1.8, the perfusion lesion volume is > 15 mL, and the established infarct volume is < 70 mL),9 we are now able to identify those who are likely to respond well. In addition,…