Treatment of Acute Stroke

Abstract

In 1998, I wrote an editorial entitled “Stroke Treatment: Promising but Still Struggling”¹ in an issue of JAMA that featured 5 articles on stroke. In that issue,² 2 articles concerned carotid artery surgery, one article reported the results of a trial of acute stroke patients receiving treatment with a heparinoid, another focused on anticoagulation in atrial fibrillation, and the fifth reviewed thrombolytic and neuroprotective treatments—each in their early years of application. During the past 6 years, there have been dramatic improvements in the technology available to diagnose stroke, and more studies have reported the results of thrombolytic therapy. This issue of JAMA includes one article on stroke diagnosis³ and 3 articles on outcomes following thrombolytic treatment with alteplase for patients with acute ischemic stroke.^4-6 As these articles suggest, while there has been some progress, stroke treatment is still struggling and has a long way to go.