The past 20 years have witnessed a revolution in the paradigm of acute ischemic stroke treatment. In 1996, intravenous alteplase was shown to improve outcomes among patients treated within 3 hours of stroke onset.1 This finding upended the historical therapeutic nihilism about stroke, and with it the leisurely armchair approach to stroke treatment. The concept of so-called acute ischemic stroke emerged. This changed the nature and practice of vascular neurology, created a vigorous and sometimes controversial debate between vascular neurologists and emergency physicians about the merits of alteplase, and paved the way for more effective methods of reperfusion in stroke, particularly for strokes arising from proximal large vessel occlusion (LVO). This was accompanied by an intense public education campaign for individuals to engage emergency medical services (EMS) for suspected stroke and a method to certify hospitals capable of delivering intravenous alteplase rapidly and safely.
Schwamm LH. Optimizing Prehospital Triage for Patients With Stroke Involving Large Vessel Occlusion: The Road Less Traveled. JAMA Neurol. 2018;75(12):1467–1469. doi:10.1001/jamaneurol.2018.2323
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