If left untreated, acute ischemic stroke may produce irreversible neuronal injury within minutes to a few hours, resulting in potentially devastating clinical outcomes. Prior to the study of fibrinolytic therapy for reperfusion, interventions to prevent these unfortunate outcomes were few, if any. Despite the fairly thorough understanding gained from animal models and the clinical observation of stroke patients of how quickly irreversible injury is produced by cerebral ischemia, many in the field were surprised by the clear and robust time-dependence of outcomes with reperfusion. Recent years have seen an intense focus on reducing delay from the time of symptom onset to hospital arrival as well as on minimizing intrahospital roadblocks, with many encouraging results.
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