Stroke Centers

See related article, pages 1102–1107. If we could magically go into the future approximately 50 years, I suspect we would look back at the current time with fond memories. I say this because we may now be living through the “Golden Era” of stroke care. Over the past 10 to 20 years, there have been several major advances in the care of patients with cerebrovascular disease. These include the ability to image in great detail the brain and related vessels, the widespread availability and use of tissue plasminogen activator, the use of endovascular approaches to treat ischemic strokes and aneurysms, and the formation of stroke centers in many parts of the world. These developments have greatly improved our ability to accurately diagnose and treat patients with stroke and improve their outcomes.In 2000, the Brain Attack Coalition (BAC) published recommendations for the formation of Primary Stroke Centers (PSCs).1 This effort was based on concerns that the level of acute stroke care in the United States was uneven at best and suboptimal in many cases. The BAC drew from the experience of Trauma Centers as a paradigm to better organize and enhance the care of patients with an acute stroke. Trauma and stroke do share several important features: (1) both occur without warning; (2) both have very limited time windows to treat and have an improved outcome and (3) both require specialized care facilities, personnel, and protocols to provide optimal care.Many elements of a PSC have been shown to effect a good or improved outcome, including stroke …