New Perspectives in Stroke Management: Old Issues and New Pathways.

Area of Science:

• Neurology
• Cardiovascular Research
• Public Health

Background:

• Stroke remains a major global cause of death and disability, imposing a significant social and economic burden.
• Traditional treatment paradigms for acute stroke were limited by strict time constraints, often referred to as 'time is brain'.

Discussion:

• The advent of advanced neuroimaging, such as computed tomography perfusion (CTP) and magnetic resonance imaging (MRI), enables precise patient selection for extended treatment windows.
• Mechanical thrombectomy has revolutionized acute stroke management, extending the therapeutic window to 24 hours post-symptom onset for select patients.
• Dedicated stroke units and novel oral anticoagulants (NOACs) for atrial fibrillation contribute to improved acute management and secondary prevention strategies.

Key Insights:

• The principle of 'time is brain' has been redefined, allowing more patients to benefit from acute interventions.
• Neuroimaging plays a crucial role in identifying salvageable brain tissue and expanding eligibility for reperfusion therapies.
• Integrated care pathways, from acute management in stroke units to effective secondary prevention, are vital for optimizing patient outcomes.

Outlook:

• Continued research into disease-modifying therapies holds promise for further enhancing recovery and reducing long-term neurological deficits.
• Personalized treatment approaches based on advanced diagnostics will likely become standard in acute stroke care.
• Focus on comprehensive stroke prevention, including management of risk factors like atrial fibrillation, is essential to mitigate the global burden of stroke.