Stroke with 2020 Vision

On the cusp of a new decade, accelerated change in the diagnosis and treatment of stroke and other neurovascular disorders has transformed the daily care of our patients. In the last few years, advanced neuroimaging, endovascular therapy, several new medications, and even new care paradigms using telestroke and mobile stroke units have markedly expanded options in stroke care. Such technologies enable providers to readily discern stroke mechanisms in a given patient and promptly tailor precision-medicine strategies to optimize an individual’s long-term clinical outcomes. From thrombectomy to secondary prevention, stroke systems of care have widely disseminated these modern approaches from urban to rural settings around the globe. In this issue, we cover practical strategies of stroke care that have recently emerged from clinical trials to routine care.

Articles in this issue span from prehospital care to secondary prevention, consider intracranial atherosclerosis and asymptomatic carotid stenosis, while addressing different types of hemorrhagic stroke. These up-to-date synopses provide snapshots of the latest approaches to stroke that can be implemented in most settings. Although stroke mortality has recently decreased, the incidence remains quite common, even amongst younger adults. As you will see, imaging has brought new clarity to stroke subtypes and characterizing what may be most important for that individual patient in front of you at the bedside or in the clinic. Treatment options have now expanded into the larger community, and it is therefore incredibly important to stay abreast of these fast-paced changes in the field.

In summary, optimizing the outcomes of our patients with stroke or those individuals with neurovascular disorders has become a concerted focus as we translate recent breakthroughs in research to daily care around the world. Neurologists encounter all types of stroke throughout a variety of settings, from prehospital triage, to acute decision-making, into the angiography suite, to the neurointensive care unit, in consultation and often from rehabilitation in the clinic to long-term follow-up of chronic conditions. A vision of precision medicine in stroke can easily adopt these newfound opportunities.