I'm focusing on the line, neuroprotection fell out of favor. Would it have fallen out of favor if it was properly referred to as the neuronal cascade of death?
Survivors in charge would never have let it fall out of favor. Will you all step aside and let survivors run this the proper way? Leading to 100% recovery.
Endovascular and hyper acute stroke management
While
advances in stroke generally continue to accelerate in terms of
prevention, acute intervention, and recovery, the speed at which these
changes are occurring is quite impressive. The introduction of
thrombolysis as the first major acute intervention in acute ischemic
stroke spreads at a fairly modest pace around the world, although it
accelerated in later years as its efficacy became more clearly
established with pooled analysis of existing trials and extension of the
therapeutic stroke window out to 4.5 h. There was undoubtedly some
reticence on the part of a smaller cohort of emergency physicians in
some parts of the world to embrace thrombolysis as a stroke therapy, but
this now has been dissipated by the tsunami of thrombectomy. The
greater efficacy of thrombectomy with numbers needed to treat as low as 3
has led to its extraordinarily rapid uptake around the globe,
particularly in the developed world. This was partly assisted by the
health care systems, particularly involving stroke units, which provided
fertile ground for the next therapeutic wave, certainly further
adjustments in health care services have been required, and more work in
this area needs to be done but not near the magnitude of change that
was initially required after thrombolysis. Of course, change in
low–middle income countries (LMICs) is taking a proportionately longer
time to install these services.
A manifestation of the dynamics of these developments has been the changing emphasis of the longstanding 14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy: Proceedings and Summary of Discussions. This is usually held as a satellite to world stroke meetings since its inception. In earlier meetings, thrombolysis was the main focus, and then neuroprotection was added but later fell out of favor. The current meeting, held in Houston recently and reported in this edition, has a strong emphasis on thrombectomy and thrombolysis. It has been a driver of intellectual thought on acute therapy.
In keeping with our acute intervention theme, we also have a meta-analysis on glial fibrillary acidic protein as a biomarker for the presence of intracerebral hemorrhage. This represents one of a number of ongoing attempts to enable a distinction to be made between hemorrhagic and ischemic stroke, which will be of particular relevance in LMICs where imaging may not be readily available. Other attempts to improve pre-hospital diagnosis of stroke also appear in this edition with pre-hospital stroke scores to identify stroke mimics and also better algorithms for emergency service call centers.
Such energy focussed on the various aspects of stroke management throughout the continuum of care seems to be producing tangible benefits. We are delighted to be a vehicle to help bring this information to our global community.
A manifestation of the dynamics of these developments has been the changing emphasis of the longstanding 14th International Symposium on Thrombolysis, Thrombectomy and Acute Stroke Therapy: Proceedings and Summary of Discussions. This is usually held as a satellite to world stroke meetings since its inception. In earlier meetings, thrombolysis was the main focus, and then neuroprotection was added but later fell out of favor. The current meeting, held in Houston recently and reported in this edition, has a strong emphasis on thrombectomy and thrombolysis. It has been a driver of intellectual thought on acute therapy.
In keeping with our acute intervention theme, we also have a meta-analysis on glial fibrillary acidic protein as a biomarker for the presence of intracerebral hemorrhage. This represents one of a number of ongoing attempts to enable a distinction to be made between hemorrhagic and ischemic stroke, which will be of particular relevance in LMICs where imaging may not be readily available. Other attempts to improve pre-hospital diagnosis of stroke also appear in this edition with pre-hospital stroke scores to identify stroke mimics and also better algorithms for emergency service call centers.
Such energy focussed on the various aspects of stroke management throughout the continuum of care seems to be producing tangible benefits. We are delighted to be a vehicle to help bring this information to our global community.
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