In 2008, after years of being the third-leading cause of death in the United States, stroke dropped to fourth. In part, this may reflect the results of a commitment made by the American Heart Association/American Stroke Association (AHA/ASA) more than a decade ago to reduce stroke, coronary heart disease, and cardiovascular risk by 25% by the year 2010 (a goal met a year early in 2009). The reason for the success was multifactorial and included improved prevention and improved care within the first hours of acute stroke. To continue these encouraging trends, the public and healthcare professionals must remain vigilant and committed to improving overall stroke care