It’s been two decades since NINDS and MAST and ECASS and the other clot-busting lore cluttering up your brain. Have we learned anything in the interim? Are we using tPA more safely, more appropriately – or just more? And, what now, of endovascular therapy, CT perfusion, and patient-level predictive modeling – are you ready for the next decade of evolution in stroke care? In this talk, we’ll go into the most recent trial evidence relating to saving neurons, and whether we should be suspicious or celebratory of their outcomes. On one hand, we have clinicians putting the low-tech non-contrast CT in a mobile stroke unit to treat more patients, while other clinicians are using rapid MRI and CT perfusion to precisely target treatment. We’ve also seen endovascular treatment finally hit prime-time after years of false starts, and systems of stroke care re-organized around its delivery. The pace of practice change – and the reliability of the evidence – is enough to give you a stroke! Finally, we’ll look at the clinical trials underway, which may produce zero, subtle, or huge changes in practice. At the minimum, we’ll at least get a handful of new acronyms to file away.