Advanced Cerebrovascular Disease Management

Jason Mackey, MD, MS

We are witnessing enormous and rapid change in stroke. A review of the stroke-specific issues of this publication over the past 30 years with regard to hyperacute ischemic stroke management alone confirms as much. An article in the 1986 edition reported the promise of tissue plasminogen activator and the 1998 edition addressed emerging endovascular therapies. The 2005 edition included a discussion of advanced multimodal imaging to assist in patient selection. And an author in 2010 included a single sentence about the promise of a “temporary stent-bypass with a retrievable device.” We are seeing the fruit of these investigations over the years and the progress in our field is undeniable.

For this issue I have asked young leaders who are already making their marks to provide perspective on some of the major changes occurring right now in stroke. These leaders are building upon the foundations of advances in ischemic stroke, intracranial and subarachnoid hemorrhages, arteriovenous malformations, and carotid disease. In this issue, they point us toward the future with engaging discussions of advanced systems of care, new technologies, and brain–computer interfaces, as a few examples. The growing multidisciplinary nature of stroke is apparent in this work and I am proud of the assembled authorship. A quick glance at the diverse backgrounds of the authors reveals neurologists, neurosurgeons, neuroradiologists, neurocritical care specialists, stroke rehabilitation specialists, and emergency medicine specialists. Space did not permit the inclusion of stroke epidemiologists, stroke telemedicine specialists, specialized stroke nurses, or hospital administrators. Actually, it was good sense that did not permit the inclusion of administrators.

I am grateful to my colleagues and friends for their hard work on these contributions. I'd like to thank Karen, too, for the opportunity to serve as the Guest Editor and for her years of insightful guidance. My hope is that the reader finds this edition not only engaging, but also inspiring as we press on as a community in the work of reducing the burden of stroke.