The modern era of stroke treatment began 20 years ago today, with the publication of the NINDS tPA trial in The New England Journal of Medicine. Back in those days, stroke was not considered treatable, and there was no urgency attached to the care of stroke patients. A CT scan was not a test that could be obtained 24/7 in most hospitals. There were no stroke teams, and very few stroke units. We owe a great debt to the investigators in this trial, both for the brilliance of the design, and their amazing dedication to the advancement of stroke care. Looking back on the trial today, it continues to be remarkable how many patients were treated within 90 minutes of stroke symptom onset. The publication of the trial led to the approval of tPA for stroke treatment in June 1996. This led to the development of stroke centers all around the world. The treatment of ischemic stroke with IV tPA is a pillar of every evidence based guideline around the world.
Stroke treatment continues to move forward, but today is time to look back and acknowledge our debt to those who built and paved the road on which we continue to travel.