In order to obtain reliable large-scale data on stroke management in Japan, we (J-MUSIC) conducted a multicenter study (consecutive registration) on stroke management from May 1999 to April 2000. During the study period, 16, 922 patients (10, 370 men and 6, 552 women) with acute ischemic stroke (≤7 days) were registered from 156 participating institutes. Results are summarized as follows. (1) Women were older than men (73.6 vs. 68.7 year-old). (2) Patients were admitted to the department of neurosurgery in 49.4%, followed by neurology in 43.5% and stroke medi-cine in 7.1%. (3) Time from onset to admission was shorter than 3 hours in 36.8%, and 6 hours in 49.5%. (4) Patients were treated in stroke/intensive care units in 18.8%, and the rest of them were mostly treated in general wards. Outcome of patients with NIHSS score? 15 were better in those treated in SCU/ICU than those in general ward. (5) The median and mean of NIH Stroke Scale score were 5 and 8.0 ± 7.9 (SD), respectively. (6) Thrombolytic therapy for acute occlusion of the cerebral artery was done only in 2.5% of the patients. (7) Clinical category of stroke was lacunar in 36.3%, atherothrombotic in 31.1%, cardioembolic in 20.4%, unclassified in 5.7%, and TIA in 6.4%. (8) Proportion of atherothrombotic infarction was larger than that of lacunar stroke in Kanto and Kinki districts (urban areas), where diabetes mellitus and hypercholesterolemia as risk factors were more common than other areas. (9) Modified Rankin Scale at discharge was "0" in 18.5%, "1" in 28.8%, "2" in 13.3%, "3" in 8.3%, "4" in 14.4%, "5" in 9.5%, and "6" (dead) in 7.0%. For better stroke managements, we need to make public education about an importance of prevention and early treatment of stroke, and to urge the government to approve tissue plasminogen activator as a therapeutic measure. In addition, we have to make effort for constructing better medical systems outside and inside the hospital for seamless care of stroke patients.
Gene transfer to blood vessels is an effective approach to alter vasomotor function, and a useful tool for studying vascular biology. Gene therapy for cerebrovascular diseases is an attractive approach, especially when pharmacological approaches are not effective. Preliminary data suggest that gene therapy may be useful for prevention of cerebral vasospasm after subarachnoid hemorrhage. As better ventors are developed, other clinical problems also may become targets for gene therapy.