LAUSR

> Our greatest weakness lies in giving up. The most certain way to succeed is always to try just one more time (Science: A Collection of Quotes; Sapiens Hub 2017). > > —Thomas A. Edison (1847–1931) We are in a brand new era of acute stroke care led by 3 monumental achievements: (1) new reperfusion therapies, (2) expansion of the time window when there is still enough brain tissue to save, and (3) better understanding of the role of neuroimaging (eg, diffusion-weighted magnetic resonance imaging or perfusion computed tomographic use for decision-making in reperfusion therapies). The current management of acute ischemic stroke has only very recently dramatically changed with the publication of randomized trials using endovascular thrombectomy (EVT).1–4 Meta-analysis and pooled analysis from these trials consistently revealed an average 2.5×-fold reduction in disability (odds ratio, 2.49; 95% confidence interval, 1.76–3.53; P 300 minutes).2,5 As a result, physicians caring for acute stroke patients were given a brand new therapeutic arsenal but might also face more complex decisions (eg, stretching the benefits of EVT trials into real-world practice, subgroups with concomitant—and less investigated—comorbid conditions, time to transfer patients to a tertiary care institution, etc). Recent analysis showed a rapid decay of clinical benefit with EVT after 7.3 hours from the time of last seen well.6 Importantly, we learned about the identification of imaging patterns for patient selection that are associated with higher or lower likelihood of achieving a favorable outcome with reperfusion therapies (eg, collateral flow, …