Raffaele Ornello, MD

Until the early 1990s, stroke was regarded as a disabling event with no cure. The NINDS trial of intravenous thrombolysis, published in 1995, changed the minds of stroke physicians and marked the rise of revascularization treatments for acute ischemic stroke. The initial criteria for patient selection were very strict. After that, more and more refined protocols were established, allowing the progressive extension of the therapeutic window and the loosening of selection criteria.

The last decade saw the rise of endovascular treatments. After the first unsuccessful trials, adequate protocols for the selection of patients with salvageable brain ischemic tissue led to success in recanalization treatments. Better use of brain neuroimaging led to refinements in patient selection, allowing the extension of time windows for treatments in eligible patients. Over the years, revascularization treatments for ischemic stroke spread over most hospitals in the world, allowing widespread access to treatments.

The history of revascularization treatments for acute ischemic stroke teaches us that selecting the right treatment for the right patient is key to attaining significant achievements. The advent of those treatments also led to a paradigm shift in ischemic stroke treatment, from therapeutic nihilism to highly organized interventional approaches. Besides, the new treatments were made possible by important technical advancements in neuroimaging and revascularization devices.

The field of acute ischemic stroke care is continuously expanding, and more and more patients with acute ischemic stroke will likely be treatable — and treated — during the next years.