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Current state and future directions for reperfusion therapy

      The global challenge of stroke is massive, with 17 million strokes each year and around 6 million deaths. Over 80% of strokes occur in low and middle income countries where there is a stroke pandemic. At least 80% of acute strokes are ischemic. Acute stroke therapy, particularly reperfusion therapies are based on salvage of the ischemic penumbra. This concept was first described 40 years ago in preclinical models. Real-time penumbral imaging using CTP or MRI is increasingly available and now well-validated. There is a major focus on providing tPA to a higher proportion of acute stroke patients within 4.5 hours. There are proven strategies using a “code stroke” team and pre-hospital notification to increase the proportion of patients receiving tPA at earlier times. Stroke telemedicine and mobile stroke units, incorporating CT scanners are other advances.
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