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STROKE TREATMENT ADVANCES

What are the significant advances in the treatment of stroke?

1920s

Contrast angiography developed.

1940s

Indicator dilution technique used to measure cerebral flow metabolism.

1950s

Recognition that carotid bifurcation disease could cause cerebral infarction, often preceded by transient ischemic attack (TIA) as a warning symptom.

First carotid endarterectomy performed.

Prosthetic heart valves introduced to patients with rheumatic heart disease to lessen the risk for embolic stroke.

1960s

Severe hypertension identified as a treatable risk factor for stroke.

Doppler ultrasonography developed.

Start of the real decline in the incidence of and mortality from stroke.

1970s

Demonstration that aspirin is effective in preventing stroke. Development of computerized tomography (CT) that radically changes early diagnosis of ischemic or hemorrhagic stroke.

Recognition of the management of risk factors for stroke associated with major decline in stroke mortality.

PET scanning provides important information about brain metabolism.

1980s

Demonstration that early aneurysm surgery incorporating advances in microsurgery and neuroanesthesia is effective in improving outcome after subarachnoid hemorrhage.

Prospective randomized trial methodology perfected.

Development of MRI that further improved evaluation of persons with cerebrovascular disease.

Interventional neuroradiology allows for more aggressive approaches to treating arterial lesions.

Other antiplatelet agents are demonstrated to be effective in lessening the risk of stroke.

Transcranial Doppler is applied clinically.

Increased emphasis on identifying the risk factors for stroke in women and minorities begins.

Increased stroke due to drug abuse is recognized.

Cigarette smoking is established conclusively as a major risk factor for stroke; and that cessation produces a significant risk reduction by two years, and risk becomes equal to that of nonsmokers by five years.

Demonstration that treating isolated systolic hypertension in the elderly reduces stroke risk.

1990s

Carotid endarterectomy is proven effective in preventing stroke among patients with severe stenosis.

Oral anticoagulants and aspirin are shown to be very effective in lessening the risk of stroke among persons with atrial fibrillation.

Conclusive evidence that specialized stroke centers decrease mortality and improve outcome for stroke.

The FDA approved the use of tissue plasminogen activator (tPA) to treat stroke in the first three hours following the onset of symptoms. tPA is one of several drugs with the ability to dissolve the blood clots responsible for causing many strokes.

Microcoils are introduced as an effective treatment for brain aneurysms.