The 2012 Feinberg Lecture

We stand poised on the threshold of a new era in care for acute ischemic stroke, in which treatments will be swift, starting in the first 60 minutes after onset, the golden hour when almost the entire threatened brain region is still salvageable, and treatments will be sure, reopening occluded arteries in almost all patients who will benefit from reperfusion. This narrative review surveys translational clinical research in prehospital neuroprotection and highly effective endovascular recanalization therapy that has helped lay the foundation for this imminent transformation.I have the honor of delivering the Feinberg Lecture in 2012, a moment of tremendous accomplishment in cerebrovascular disease care. We are preventing and treating acute stroke better than ever before. In the United States, over the past 50 years, the per capita incidence of stroke mortality has decreased by 75%, an immense public health achievement.1 Stroke recently declined from the third to the fourth leading cause of death among Americans. Stroke-prevention trialists find it increasingly difficult to demonstrate benefits of technologically remarkable new treatments because our evolving standard prevention care (past trials translated into practice) has already reduced recurrent vascular event rates to extraordinarily low levels.2And yet, ours is also a time of increasing peril from cerebrovascular disease. Stroke continues to be a leading cause of disability, death, and dementia worldwide. Moreover, with the aging of the US populace, projections forecast that increasing numbers of acute stroke patients will present to our hospitals every year throughout the next 2 decades.3As a consequence, the theme of this Feinberg lecture is especially urgent: improving acute ischemic stroke therapy. While our treatments for acute stroke have improved over time, they remain much less effective than our prevention therapies. We have only a small set of proven interventions: intravenous tissue plasminogen activator …