The Alphabet of Imaging in Acute Stroke

If we are to improve stroke treatment, we first need to assess the current state of affairs. Consider the next 100 patients with acute ischemic stroke in the United States, screened with noncontrast computerized tomography and treated with intravenous tissue-type plasminogen activator (IV tPA) within 3 to 4.5 hours, as recommended. On the average, only ≈5 of those individuals will actually get IV tPA1; of those treated, only ≈1 of 5 will benefit.2 So, from our cohort of 100 patients, in the end, only 1/100 will get benefit from the only US Food and Drug Administration–approved acute stroke therapy. This is despite more than a decade of intense effort by stroke-related societies, pharmaceutical partners, hospital programs, and the tireless individual efforts of countless physicians, nurses, pharmacists, and emergency responders to “Get With the Guidelines” and expeditiously treat as many stroke victims as possible. Even in highly effective stroke centers where 10% to 20% …