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Neurotherapeutics
Published in: Neurotherapeutics 3/2023

01-04-2023 | Stroke | Review

What’s the Future of Vascular Neurology?

Authors: Rebecca F. Gottesman, Lawrence Latour

Published in: Neurotherapeutics | Issue 3/2023

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Abstract

The field of vascular neurology has made tremendous advances over the last several decades, with major shifts in diagnosis, treatment, prevention, and rehabilitation of patients with stroke. Furthermore, the individuals who are providing the care represent a different cohort than those who were caring for stroke patients 30 years ago, with the increasing need for rapid decision-making for acute interventions and a larger workforce being needed to provide the many complicated aspects of care of stroke patients. Understanding the history of the field is critical before one can speculate about its future directions. In summarizing some of the past massive shifts in the past few decades, this review will discuss future opportunities and future challenges and will introduce the rest of this special issue focusing on vascular neurology in a post-thrombectomy era. Although thrombolysis and thrombectomy remain a major part of ischemic stroke management and care, in the coming years, there will likely be further modifications in how we provide the care, who provides it, how we train those individuals who provide it, where it is provided, and what data inform early management decisions.
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Literature
1.
The NINDS rt-PA Study Group. Tissue plasminogen activator for acute ischemic stroke. New Eng J Med. 1995;333:1581–8.
2.
Campbell BCV, Meretoja A, Donnan GA, Davis SM. Twenty-year history of the evolution of stroke thrombolysis with intravenous alteplase to reduce long-term disability. Stroke. 2015;46:2341–6.PubMedCrossRef
3.
Ingall TJ, O’Fallon WM, Asplund K, et al. Findings from the reanalysis of the NINDS tissue plasminogen activator for acute ischemic stroke treatment trial. Stroke. 2004;35:2418–24.PubMedCrossRef
4.
Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29.
5.
Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2014;7:CD000213.
6.
7.
Meretoja A, Keshtkaran M, Saver JL, et al. Stroke thrombolysis: save a minute, save a day. Stroke. 2014;45:1053–8.PubMedCrossRef
8.
Fonarow GC, Zhao X, Smith EE, et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quallity improvement initiative. JAMA. 2014;311(16):1632–40.PubMedCrossRef
9.
Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/ American Stroke Association. Stroke. 2018;49:e46–99.PubMedCrossRef
10.
11.
Kwan J. Letter to the editor, in response to: Vascular neurology: a new neurologic subspecialty. Neurology. 2004;63:774–6.CrossRef
12.
Adams Jr. HP, Kenton EJr, Scheiber SC, Juul D. Vascular neurology: a new neurologic subspecialty. Neurology. 2004;63(5):774–6.
13.
14.
Lees KR. Stroke is best managed by a neurologist: battle of the titans. Stroke. 2003;34(11):2764–5.PubMedCrossRef
15.
16.
Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside. The Brain Attack Study Stroke. 2006;37:769–75.PubMed
17.
Briard JN, Zewude RT, Kate MP, et al. Stroke mimics transported by emergency medical services to a comprehensive stroke center: the magnitude of the problem. J Stroke Cerebrovasc Dis. 2018;27(10):2738–45.CrossRef
18.
Faiz KW, Labberton AS, Thommessen B, Ronning OM, Dahl FA, Barra M. The burden of stroke mimics: present and future projections. J Stroke Cerebrovasc Dis. 2018;27(5):1288–95.PubMedCrossRef
19.
Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the brain attack study. Stroke. 2006;37(3):769–75.PubMedCrossRef
20.
Ferro JM, Pinto AN, Falcao I, et al. Diagnosis of stroke by the nonneurologist. A validation study Stroke. 1998;29(6):1106–9.PubMed
21.
Kothari RU, Brott T, Broderick JP, Hamilton CA. Emergency physicians. Accuracy in the diagnosis of stroke. Stroke. 1995;26(12):2238–41.
22.
Ferro JM, Falcao I, Rodrigues G, et al. Diagnosis of transient ischemic attack by the nonneurologist. A validation study. Stroke. 1996;27(12):2225–9.PubMed
23.
Ali-Ahmed F, Federspiel JJ, Liang L, et al. Intravenous tissue plasminogen activator in stroke mimics. Circ Cardiovasc Qual Outcomes. 2019;12(8): e005609.PubMedPubMedCentralCrossRef
24.
Jovin TG, Li C, Wu L, et al. Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med. 2022;387:1373–84.PubMedCrossRef
25.
Tao C, Nogueira RG, Zhu Y, et al. Trial of endovascular treatment of acute basilar-artery occlusion. N Engl J Med. 2022;387:1361–72.PubMedCrossRef
26.
27.
28.
Leira EC, Kaskie B, Froehler MT, Adams Jr. HP. The growing shortage of vascular neurologists in the era of health reform. Planning is brain! Stroke. 2013;44:822–7.
29.
Smith MA, Liou J-I, Frytak JR, Finch MD. 30-day survival and rehospitalization for stroke patients according to physician specialty. Cerebrovasc Dis. 2006;22(1):21–6.PubMedCrossRef
30.
Sacchetti DC, Gupta A, Chung CD, et al. Vascular neurologists’ involvement in the care of Medicare patients with ischemic stroke. The Neurohospitalist. 2020;10(3):181–7.PubMedPubMedCentralCrossRef
31.
32.
Wilcock AD, Schwamm LH, Zubizarreta JR, et al. Reperfusion treatment and stroke outcomes in hospitals with telestroke capacity. JAMA Neurol. 2021;78(5):527–35.PubMedCrossRef
33.
Sharma R, Zachrison KS, Viswanathan A, et al. Trends in telestroke care delivery: a 15-year experience of an academic hub and its network of spokes. Circ Cardiovasc Qual Outcomes. 2020;13(3): e005903.PubMedPubMedCentralCrossRef
34.
35.
Albright KC, Boehme AK, Mullen MT, et al. The effect of telemedicine on access to acute stroke care in Texas: the story of age inequalities. Stroke Res Treat. 2015;813493.
36.
Zachrison KS, Cash RE, Adeoye O, et al. Estimated population access to acute stroke and telestroke centers in the US, 2019. JAMA Netw Open. 2022;5(2):e2145824.
37.
Vagal A, Wintermark M, Nael K, et al. Automated CT perfusion imaging for acute ischemic stroke. Pearls and pitfalls for real-world use. Neurology. 2019;93(20):888–98.
38.
39.
Mair G, White P, Bath PM, et al. External validation of e-ASPECTS software for interpreting brain CT in stroke. Ann Neurol. 2022;92(6):943–957.
40.
Kokkotis C, Giarmatzis G, Giannakou E, et al. An explainable machine learning pipeline for stroke prediction on imbalanced data. Diagnostics (Basel). 2022;12(10):2392.PubMedCrossRef
41.
Zhang H, Chen H, Zhang C, et al. A radiomics feature-based machine learning models to detect brainstem infarction (RMEBI) may enable early diagnosis in non-contrast enhanced CT. Euro Radiol. 2023;33(2):1004–1014.
42.
Allen M, James C, Frost J, et al. Use of clincial pathway simulation and machine learning to identify key levers for maximizing the benefit of intravenous thrombolysis in acute stroke. Stroke. 2022;53(9):2758–67.PubMedPubMedCentralCrossRef
43.
Shuaib A, Arian H, Shuaib A. The increasing role of artificial intelligence in health care: will robots replace doctors in the future? Int J Gen Med. 2020;13:891–6.PubMedPubMedCentralCrossRef
44.
Wardlaw JM, Mair G, von Kummer R, et al. Accuracy of automated computer-aided diagnosis for stroke imaging: a critical evaluation of current evidence. Stroke. 2022;53:2393–403.PubMedCrossRef
45.
Vagal A, Wintermark M, Nael K, et al. Automated CT perfusion imaging for acute ischemic stroke. Pearls and pitfals for real-world use. Neurology. 2019;93(20):888–98.
46.
Hu N, Zhang T, Wu Y, et al. Detecting brain lesions in suspected acute ischemic stroke with CT-based synthetic MRI using generative adversarial networks. Annals of Translational Medicine. 2022;10(2):35.PubMedPubMedCentralCrossRef
47.
Benzakoun J, Deslys M-A, Legrand L, et al. Synthetic FLAIR as a substitute for FLAIR sequence in acute ischemic stroke. Radiology. 2022;303(1):153–9.PubMedCrossRef
48.
Chavva IR, Crawford AL, Mazurek MH, et al. Deep learning applications for acute stroke management. Ann Neurol. 2022;92(4):574–87.PubMedCrossRef
49.
Evans A, Harraf F, Donaldson N, Kalra L. Randomized controlled study of stroke unit care versus stroke team care in different stroke subtypes. Stroke. 2002;33(2):449–55.PubMedCrossRef
50.
Walter S, Kostpopoulos P, Haass A, et al. Bringing the hospital to the patient: First treatment of stroke patients at the emergency site. PLoS ONE. 2010;5(10): e13758.PubMedPubMedCentralCrossRef
51.
Rohmann JL, Piccininni M, Ebinger M, et al. Effect of mobile stroke unit dispatch in all patients with acute stroke or TIA. Ann Neurol. 2023;93(1):50–63.
52.
Grotta JC, Yamal J-M, Parker SA, et al. Prospective, multicenter, controlled trial of mobile stroke units. N Engl J Med. 2021;385:971–81.PubMedCrossRef
53.
54.
van den Berg SA, Uniken Venema SM, Reinink H, et al. Prehospital transdermal glyceryl trinitrate in patients with presumed acute stroke (MR ASAP): an ambulance-based, multicentre, randomised, open-label, blinded endpoint, phase 3 trial. Lancet Neurol. 2022;21(11):971–81.PubMedCrossRef
55.
Bender MT, Mattingly TK, Rahmani R, et al. Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy. Stroke Vasc Neurol. 2022;7(3):209–14.PubMedCrossRef
56.
Asif KS, Otite FO, Desai SM, et al. Mechanical thrombectomy global access for stroke (MT-GLASS): a mission thrombectomy (MT-2020 Plus) Study. Circulation. 2023;147(16):1208–1220.
57.
Grotta JC, Lyden P, Brott T. Rethinking training and distribution of vascular neurology interventionists in the era of thrombectomy. Stroke. 2017;48(23):2313–7.PubMedCrossRef
58.
Maqsood H, Naveed S, Younus S, Khan MT, Khosa F. Gender and racial trends among vascular neurology fellowship programs: by design or by default. Cureus. 2021;13(9): e17740.PubMedPubMedCentral
59.
Das S, Farkas N, Binkley M, et al. Trends in racial and ethnic diversity in vascular neurology fellowships from 2006 to 2018: a cross-sectional analysis. Stroke. 2022;53(3):867–74.PubMedCrossRef
60.
61.
Jagolino-Cole AL, Bozorgui S, Ankrom CM, et al. Benchmarking telestroke proficiency: page-to-needle time among neurovascular fellows and attendings. Stroke. 2017;48(9):2618–20.PubMedCrossRef
62.
63.
64.
Mahajan A, Cahill C, Scharf E, et al. Neurology residency training in 2017. A survey of preparation, perspectives, and plans. Neurology. 2019;92(2):76–83.
65.
Prabhakaran S, Lee J, O’Neill K. Regional learning collaboratives produce rapid and sustainable iimprovements in stroke thrombolysis times. Circ Cardiovas Qual Outcom. 2016;9(5):585–92.
66.
Rost NS, Meschia JF, Gottesman R, et al. Cognitive impairment and dementia after stroke: Design and rationale for the DISCOVERY study. Stroke. 2021;52(8):e499–516.PubMedPubMedCentralCrossRef
67.
Wang Y, Meng X, Wang A, et al. Ticagrelor versus clopidogrel in CYP2C19 loss-of-function carriers with stroke or TIA. N Engl J Med. 2021;385(27):2520–30.PubMedCrossRef
68.
Yang S-H, Lou M, Luo B, Jiang W-J, Liu R. Precision medicine for ischemic stroke, let’s move beyond time is brain. Transl Stroke Res. 2018;9(2):93–5.PubMedCrossRef
69.
Bonkhoff AK, Grefkes C. Precision medicine in stroke: towards personalized outcome predictions using artificial intelligence. Brain. 2022;145(2):457–75.PubMedCrossRef
70.
Bernhardt J, Hayward KS, Kwakkel G, et al. Agreed definitions and a shared vision for new standards in stroke recovery research: the stroke recovery and rehabilitation roundtable taskforce. Int J Stroke. 2017;12(5):444–50.PubMedCrossRef
71.
72.
Sarfo FS, Ulasavets U, Opare-Sem OK, Ovbiagele B. Tele-rehabilitation after stroke: an updated systematic review of the literature. J Stroke Cerebrovasc Dis. 2018;27(9):2306–18.PubMedPubMedCentralCrossRef
Metadata
Title
What’s the Future of Vascular Neurology?
Authors
Rebecca F. Gottesman
Lawrence Latour
Publication date
01-04-2023
Publisher
Springer International Publishing
Published in
Neurotherapeutics / Issue 3/2023
Print ISSN: 1933-7213
Electronic ISSN: 1878-7479
DOI
https://doi.org/10.1007/s13311-023-01374-4

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