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(Stroke. 1999;30:1722-1728.)
© 1999 American Heart Association, Inc.

Special Reports

Acute Stroke Therapy at the Millennium: Consummating the Marriage Between the Laboratory and Bedside

The Feinberg Lecture

James C. Grotta, MD

Correspondence to James C. Grotta, MD, Professor of Neurology and Director Stroke Program, University of Texas–Houston Medical School, 6431 Fannin, Houston, TX 77030. E-mail jgrotta@neuro.med.uth.tmc.edu

Key Words: American Heart Association • rtPA • thrombolysis • neuroprotection • clinical trials • research

	Introduction

 
Those of us in the stroke field have a big job ahead of us. When I started attending this meeting 20 years ago, most of the papers related to acute stroke therapy were laboratory related. Now, of course, we are in the era of clinical trials. But in designing clinical trials, we cannot forget the lessons that need to be learned from laboratory research. And it's the job of the stroke neurologist to marry these 2 together, and that's the main focus of what I'd like to talk about in the next few minutes.

I'd like to make 4 key points. First, that stroke therapy is difficult. It's a complex disease, and nobody said it would be easy. There are not going to be any magic bullets for stroke patients. Second, the most critical but ignored lesson from the laboratory is the importance of time. Third, it's critical to change the role of neurologists in taking care of stroke patients, particularly because of the importance of time. Finally, I'd like to make a few comments about the direction of future stroke research.

The bad news for acute stroke therapy is that as far as translating what we've done in the laboratory to clinical reality, stroke has been and always will be difficult to treat. We should expect small advances and many failures, and for every 1 positive clinical trial, we will probably have many negative ones; that's just the nature of stroke disease. But substantial attenuation of damage is possible.

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