High explosive treatment for ultra Acute Stroke

High explosive treatment for ultra Acute Stroke - is it a hype or hope?

Treatments for acute stroke can be categorized in to four groups. They are 1. Target population based(Ischemic stroke, Intra Cerebral Hemorrhage), 2. Utility ( Proportion of patients who can be treated), 3. magnitude of efficacy and 4.cost.  We can also divide them as High cost therapies and low cost therapies. High cost therapies can be justified of there is high efficacy ( intravenous alteplase, mechanical thrombectomy, hemicraniectomy). Aspirin, the cost therapy typically will have low efficacy. Is it not reasonable to expect and see that medium to high efficacy therapies which are inexpensive are available to our patients.

Intensive blood pressure control has been found to be beneficial in ICH (INTERACT- II trial), but we are not clear if intensive blood pressure is helpful in ischemic stroke patients!

In the recent studies (ENOS trial, RIGHT trial) early GTN therapy has shown benefits in ICH, Ischemic stroke patients. This may change the future of the early stroke management even before the patients are shifted to the hospitals. GTN, the explosive may change the future game plan! Is it a hype or hope? we have to see !!