Turgut Tatlisumak Stroke Care : European Perspective Implication of the Recent Positive Endovascular Intervention Trials for Organizing Acute

—Timely recanalization leads to improved patient outcomes in acute ischemic stroke. Recent trial results demonstrated a strong benefit for endovascular therapies over standard medical care in patients with acute ischemic stroke and a major intracranial artery occlusion ≤6 hours or even beyond from symptom onset and independent of patients' age. Previous studies have shown the benefit of intravenous thrombolysis that had gradually, albeit slowly, reshaped acute stroke care worldwide. Now, given the superior benefits of endovascular intervention, the whole structure of acute stroke care needs to be reorganized to meet patient needs and to deliver evidence-based treatments effectively. However, a blueprint for success with novel stroke treatments should be composed of numerous elements and requires efforts from various parties. Regarding the endovascular therapies, the strengths of Europe include highly organized democratic society structures, high rate of urbanization, well-developed revenue-based healthcare systems, and high income levels, whereas the obstacles include the east-west disparity in wealth, the ongoing economic crisis hindering spread of fairly costly new treatments, and the quickly aging population putting more demands on health care in general. Regional and national plans for covering whole population with 24/7 adequate acute stroke care are necessary in close cooperation of professionals and decision-makers. Europe-wide new training programs for expert physicians in stroke care should be initiated shortly. European Stroke Organisation has a unique role in providing expertise, consultation, guidelines, and versatile training in meeting new demands in stroke care. This article discusses the current situation, prospects, and challenges in Europe offering personal views on potential solutions. The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association. T imely recanalization is the most powerful predictor of improved outcome in patients with acute ischemic stroke (AIS). 1 However, delay in presentation at a fully equipped stroke center is the major reason why patients with AIS are not eligible for recanalization therapy with intravenous throm-bolysis (IVT) or endovascular interventions (EVI). Early presentation not only increases the proportion of patients treated, but the earlier the treatment is given, the greater the treatment benefit will be: saving 1 minute in initiating IVT leads to one additional healthy day of life in average (hence the term: " save a minute, save a day "). 2 Conversely, delayed treatments are associated with mitigated or no benefits along with an increasing risk for intracranial hemorrhages. 3 Timely arriving patients are evaluated …