Each year almost 800,000 people suffer a new or recurrent stroke. Of these, 87 % ischemic strokes, due to a blockage of vessels going into the brain. About 55,000 more women suffer from strokes a year, and in general women are more likely to have a stroke [1]. Ischemic strokes are most commonly caused by either a rupture of an atherosclerotic plaque, or by a blood clot that forms in another part of the body (most commonly the heart) and travels into the blood vessels of the brain.

Ischemic strokes can occur suddenly and can lead to devastating consequences. Timely recognition and response is critical. The American Stroke Association has created the F.A.S.T. mnemonic to aid the diagnosis of an ischemic stroke and to facilitate delivery of patients to the hospital. F.A.S.T stands for “(F)acial droop, (A)rm weakness, (S)peech difficulty, (T)ime to call 911.”The first three letters represent some of the most common symptoms of an ischemic stroke, and stress the urgency of quickly transporting patients to the nearest hospital for evaluation and possible transfer to a stroke center.

Once at a stroke center, the patient is evaluated by stroke neurologists. If warranted, the next step in work up will usually include specialized imaging, such as computed tomography (CT) of the head with or without perfusion. If there is no evidence of a bleed found on the head CT, and if there is a strong suspicion for an ischemic stroke, the patient will be evaluated for treatment.

Currently, the only FDA approved treatment for ischemic strokes is the administration of intravenous tissue plasminogen activator (IV tPA), known more colloquially as a “clot buster.” Current guidelines state that IV tPA must be administered within 4.5 h after the onset of symptoms [2]. Patients who are candidates for receiving IV tPA include patients who are more than 18 years of age and have a clinical diagnosis of an ischemic stroke. Some patients are not eligible for IV tPA, such as those with active or recent bleeding (including intracranial hemorrhage), major surgery or trauma in the previous 2 weeks, GI or urinary bleeding within 3 weeks, or a systolic blood pressure of greater than 185 mmHg or a diastolic blood pressure of more than 110 mmHg.