'Time' for success

摘要

Successful endovascular therapy for acute ischemic stroke (AIS) requires optimal patient selection and effective tools, and also the rapid delivery of treatment from the time of symptom onset. Time to treatment for patients with AIS remains, arguably, the most important modifiable factor in improving outcomes. Although intravenous tissue plasmino-gen activator (tPA) administration has been extended to 4.5 h, fewer than one-third of eligible patients receive it within the target door to needle (DTN) time of 60 min.3 This failure to achieve benchmark times has led to 'Target: Stroke', a national quality improvement initiative of the American Heart Association/American Stroke Association which aims to increase the timeliness of intravenous tPA administration. Over the past 20 years, tremendous efforts in developing primary stroke centers and implementing strategies based on the development of these centers have led to a dramatic reduction in DTN times, but there is much room for improvement.