New Era for Stroke Therapy: Is This a Global Perspective?

Correspondence Stroke is a leading cause of mortality and disability in many countries, especially in developing countries, like South America. Unfortunately, in South American countries, the treatment of stroke is still far from adequate [1]. Intravenous thrombolysis in the treatment of stroke is performed in a minority of cases and is basically done in big cities. Stroke networks cannot reach smaller localities where millions of people live. Since the development of studies for the use of intravenous thrombolytic therapy for stroke treatment (NINDS and ECASS), many people have benefited from this treatment [2, 3]. Nowadays, new techniques for acute treatment of stroke have been shown to be superior to the gold standard treatment that is available [4–7]. However, in developing countries, may be this type of therapy will benefit a smaller proportion of patients when compared to intravenous thrombolysis. In countries like Brazil, where stroke is a public health problem, to train and to prepare professionals to perform this type of treatment is a priority. The development of neurological centers that can perform endovascular treatment 24/7 will modify the stroke disability. However, I think that more important for these countries is still the organization of stroke networks, aiming to target the patients who will benefit from this type of treatment to large centers and the improvement of care at the level of basic health units. Another important point is that these results that we are discussing are from clinical trials. It is important that a large stroke data bank showing these results in the 'real world' exists. In the last European Stroke Conference, to participate in this discussion was extremely motivating for anyone working with stroke. Moreover, we think that such therapies will be used in a smaller number of patients using rt-PA. I would like to add an important issue raised by Dr Hennereci in this excellent discussion [8]. How can these new techniques reach a larger number of cases? In summary, we have a lot of work ahead and we now have another excellent therapeutic option. Investigators: Randomized assessment of rapid endovascular treatment of ischemic stroke. Investigators: Endovascular therapy for ischemic stroke with perfusion-imaging selection. Thrombectomy within 8 hours after symptom onset in ischemic stroke. PRIME Investigators: Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke.