William M. Feinberg Award for Excellence in Clinical Stroke

Proven treatments for acute stroke can be categorized by target population (ischemic stroke [IS], intracerebral hemorrhage [ICH], or both), utility (proportion of patients who can be treated), magnitude of efficacy, and cost. In general, high-cost interventions need to have high efficacy for health economic reasons; examples include intravenous alteplase, mechanical thrombectomy, and hemicraniectomy. Conversely, low-cost interventions, such as aspirin, typically have low efficacy. Having a medium-to-high efficacy intervention that was inexpensive and could be used worldwide in both IS and ICH would be a major advantage.High blood pressure (BP) is common in acute stroke and associated independently with poor functional outcome, increased death, and early recurrence (IS) and hematoma expansion (ICH).1,2 Although debated since 1985,3 it was only recently demonstrated in the INTERACT-2 (Intensive Blood Pressure Reduction in Acute Cerebral Hemorrhage Trial-2) trial that intensive BP lowering was beneficial,4 as now promoted in international guidelines.5,6 In contrast, whether BP should be lowered acutely in IS remains unclear.7–9Nitric oxide (NO) is a diatomic gaseous molecule of nitrogen and oxygen that is highly reactive and short lived. However, it is a fundamental physiological control and defense molecule that may have been used by early organisms as far back as 3 billion years.10 In human physiology, it has vascular regulatory, neurotransmitter, anti-infection, and reproductive roles. NO is synthesized from the amino acid L-arginine by 3 enzymes: endothelial, inducible, and neuronal NO synthase. Many effects of NO are mediated through the second messenger cGMP, which is catalyzed by guanylate cyclase from guanylate triphosphate. cGMP levels may be maintained by phosphodiesterase-5 inhibitors such as dipyridamole. NO is inactivated through oxidation to nitrite then nitrate; this reaction may be reversed and it now appears that NO may be synthesized from nitrate …