| 1920s |
- Contrast angiography developed.
|
| 1940s |
- Indicator dilution technique used to measure cerebral flow metabolism.
|
| 1950s |
- Recognition that carotid bifurcation disease could cause cerebral infarction, often
preceded by transient ischemic attack (TIA) as a warning symptom.
- First carotid endarterectomy performed.
- Prosthetic heart valves introduced to patients with rheumatic heart disease to lessen
the risk for embolic stroke.
|
| 1960s |
- Severe hypertension identified as a treatable risk factor for stroke.
- Doppler ultrasonography developed.
- Start of the real decline in the incidence of and mortality from stroke.
|
| 1970s |
- Demonstration that aspirin effective in preventing stroke.
- Development of computerized tomography (CT) that radically changes early diagnosis of
ischemic or hemorrhagic stroke.
- Recognition of the management of risk factors for stroke associated with major decline
in stroke mortality.
- PET scanning provides important information about brain metabolism.
|
| 1980s |
- Demonstration that early aneurysm surgery incorporating advances in microsurgery and
neuroanesthesia effective in improving outcome after subarachnoid hemorrhage.
- Prospective randomized trial methodology perfected.
- Development of MRI that further improved evaluation of persons with cerebrovascular
disease.
- Interventional neuroradiology allows for more aggressive approaches to treatment of
arterial lesions.
- Ticlopidine,another antiplatelet drug, is demonstrated to be effective in lessening the
risk of stroke.
- Transcranial Doppler applied clinically.
- Increased emphasis on identifying the risk factors for stroke in women and minorities
begin.
- Increased stroke due to drug abuse recognized.
- Cigarette smoking is established conclusively as a major risk factor for stroke; and
that cessation produces a significant risk reduction by two years, and to that of
nonsmokers by five years.
- Demonstration that the treating isolated systolic hypertension in the elderly reduces
stroke risk.
|
| 1990s |
- Carotid endarterectomy is proven to be effective in preventing stroke among patients
with severe stenosis.
- Oral anticoagulants and aspirin are shown to be very effective in lessening the risk of
stroke among persons with atrial fibrillation.
- Oral anticoagulants superior to aspirin in preventing further strokes when a stroke
patient has atrial fibrillation
- Conclusive evidence that specialized stroke centers decrease mortality and improve
outcome for stroke.
- Secondary prevention trials emphasise the role of reducing blood pressure and reducing
cholesterol.
- The FDA approved the use of the thrombolytic drug, tissue plasminogen activator (TPA),
to treat stroke in the first three hours.
- The addition of dipyridamole to low-dose aspirin increases the apparent protection of
either anti-platelet drug in secondary prevention.
|
Dr R S MacWalter