Transforming the management of stroke
Effective strategies for improving outcomes require efficient triage and interdisciplinary cooperation
When I commenced work as a junior neurologist, one of the first patients admitted under my care was a woman with a history of atrial fibrillation who presented acutely with a major stroke in her dominant hemisphere, causing aphasia and a dense right-sided hemiparesis. After examining the woman, I explained to her son — one of my colleagues — that the prognosis was poor; should his mother survive, she would probably be left with significant long term disability. He responded that he had just read a report in Nature about removing clots from blood vessels to reperfuse the brain during an acute stroke. The approach seemed rational, although it appeared to rest more in the realm of science fiction than something that would be of practical clinical use anytime soon.
Twenty years later, the time for intervention and clot retrieval in stroke has arrived (Box). Following a series of ground-breaking trials that have established the benefit of mechanical thrombectomy, the management of acute stroke has dramatically changed for the better. Specifically, the natural history of potentially life-threatening stroke has been completely transformed, and patients treated within the optimal time frame are now walking out of hospital with only a minimal or no deficit.