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DOI: 10.1055/s-0030-1268857
© Thieme Medical Publishers
Stroke
Publication History
Publication Date:
04 January 2011 (online)

I am honored to be invited as the guest editor of this Seminars in Neurology issue on cerebrovascular disease and stroke. I arrived at Mayo Clinic, Rochester, Minnesota as a naïve resident in 1995 not completely sure where my career would lead. Two important things that year changed my career direction toward cerebrovascular disease. One was working with many wonderful cerebrovascular physicians and mentors, the other was the advent of the use of IV-TPA for acute ischemic stroke. The NINDS thrombolytic trial for acute ischemic stroke was published in the New England Journal of Medicine in December of that same year.
Since 1995, the field of cerebrovascular disease and stroke has evolved tremendously and choosing topics for this issue was difficult. I wanted this issue to appeal to a broad neurology community with topics that are commonly encountered in clinical practice. As a secondary and perhaps selfish goal, I wanted a group of articles that were helpful for residents rotating on my cerebrovascular hospital service and that I could provide to other neurologists who commonly ask me cerebrovascular questions.
The first group of articles focuses on acute intervention in ischemic stroke—medical management, endovascular options, and the utility of telestroke systems in acute stroke. Dr. Kevin Barrett and James Meschia, from Mayo Clinic Jacksonville, discuss the current state of medical treatment, including the use of IV-TPA, in patients with acute ischemic stroke. Dr. Barrett is neurohospitalist with clinical and research interests in the area of acute stroke therapeutics and hypoxic-ischemic brain injury. Dr. Meschia is professor of neurology and the cerebrovascular division chair of Mayo Clinic. His clinical interests include acute stroke management and his research focuses on the genetics of cerebrovascular disease. Drs. Grigoryan and Quereshi expand further on acute stroke treatment, focusing on endovascular treatments. In this up-to-date article, the current state of endovascular treatments are outlined in addition to practical implications surrounding the evolving data. Dr. Grigoryan is currently an endovascular fellow under Dr. Quereshi at the University of Minnesota. He completed his residency at the University of Iowa and a prior stroke and critical care fellowship at Stanford. Dr. Quereshi is one of the world-renowned experts in the cerebrovascular endovascular field and is widely published on a multitude of cerebrovascular topics. Although IV-TPA and endovascular options are exciting advances in the field of stroke, not everyone has access to these options. Telestroke Medicine is an emerging way to help bridge the gap in rural areas where stroke neurologists may not be readily available. Dr. Bart Demarshaelk is one of the leading experts in the country on Telestroke Medicine and shares his experience in his article entitled, “Telestrokologists: Treating Stroke Patients Here, There, and Everywhere with Telemedicine.”
Once acute interventions are made, ischemic stroke management involves determining a mechanism, choosing appropriate antithrombotics, and preventing complications. The next group of articles discusses those commonly encountered issues. Dr. Yousef Mohammed, Marc Lazzaro, and Konarc Malhotra review antithrombotic use in ischemic stroke. Dr. Mohammad is an associate professor of neurology at Rush University in Chicago. He is interested in stroke epidemiology and the mechanism of migraine headache. Dr. Mohammad's research associates, Drs. Malhoutra and Lazzaro are interested in acute stroke treatments. Dr. Lazzaro completed a neurology residency at Rush University and is currently in an endovascular neuroradiology fellowship at the Medical College of Wisconsin. Drs. Dawson and Freeman discuss complications of stroke and their prevention and treatment. Dr. Dawson is currently in his final year of residency at Mayo Clinic Jacksonville. He is pursuing training as a neurohospitalist in the near future. Dr. Freeman is an assistant professor of neurology at Mayo Clinic Jacksonville. He is trained as a neuro-intensivist. His clinical and research interests include critical care neurology, intracerebral and subarachnoid hemorrhage. Stroke rehabilitation is also employed early on after the diagnosis of stroke has been made. Drs. Schultz and Brown provide a nice review of advances in stroke rehabilitation. Dr. Schultz completed a physical medicine and rehabilitation residency and is currently a fellow in Richmond Virginia studying acquired brain injury. Dr. Allen Brown is an associate professor of physical medicine and rehabilitation and the current director of brain rehabilitation and research at Mayo Clinic Rochester.
Two of the most common causes of ischemic stroke include atrial fibrillation and carotid artery disease. Each of these fields has advanced significantly over the last several years and each deserves special attention. Dr. Holmes is professor of medicine and the current president-elect of the American College of Cardiology. He was the principal investigator of the WATCHMAN device for atrial fibrillation and stroke prevention. His expertise is shared in the article entitled, “Atrial Fibrillation and Stroke Management: Present and Future.” Dr. Guiseppe Lanzino is professor of neurosurgery with expertise in surgical and endovascular approaches to cerebrovascular disease. He and colleagues, Tiaziano Tillarita and Alejandro Rabinstein provide a state-of-the-art review of carotid artery disease and its management including its controversial issues. Dr. Tillarita is currently a research fellow in vascular surgery at Mayo Clinic Rochester with a specific interest in carotid disease. Dr. Rabinstein is an associate professor of neurology and neurointensivist at the Mayo Clinic Rochester.
The second group of articles focuses on hemorrhagic stroke. With advances in neuroimaging and its increased utility, unruptured intracranial aneurysms are a common radiographic finding. Which aneurysms stabilize and which ones have a high risk of rupture has been debated; however, Dr. Brown provides a practical approach to the discovery of unruptured intracranial aneurysms. He has played a key role in the International Study of Unruptured Intracranial Aneurysm Study and several familial intracranial aneurysm studies. A general overview of subarachnoid hemorrhage is provided by Drs. Dupont, Rabinstein, Wijdicks, and Lanzino. Dr. Dupont completed a 2-year stroke fellowship at the Mayo Clinic Rochester and is on staff at the Cleveland Clinic. Intracerebral hemorrhage is also a commonly encountered entity. Dr. Aguilar and Freeman provide a general overview to spontaneous intracerebral hemorrhage. They nicely review the recent surgical and medical literature in this area. Dr. Aguilar is an assistant professor of neurology at Mayo Clinic Arizona. Her clinical and research interests include intracerebral hemorrhage, stroke in women, and the relationship of sleep disorders and stroke. Dr. Flaherty, from the University of Cincinnati, is an expert on the epidemiology and management of intracranial hemorrhage and has a special interest in those occurring while patients are anticoagulated. Dr. Flaherty nicely outlines the epidemiology, clinical scenarios, and current management recommendations of this commonly encountered situation.
I would like to thank Karen Roos for giving me the opportunity to guest edit this issue and Linda Hagan for her tremendous help and resource. I would also like to thank the individual contributing authors for their hard work and ongoing dedication to teaching.
Kelly D FlemmingM.D.
Department of Neurology, Mayo Clinic
200 First Street SW, Rochester, MN 55905
Email: flemming.kelly@mayo.edu