Future application - prognosis determination

Precision medicine represents the future for improving outcome determination. Expanding precision medicine to the stroke area in order to identify prognostic markers is therefore crucial although challenging. The implementation of this concept in clinical practice is still far from being a reality and healthcare disparities could limit the acceleration of the translation from the science of precision medicine into clinical practice around the world. To achieve this goal, new approaches and strategies along with novel technologies, informatics, and identification of practical clinical paradigms need to be implemented. The great amount of data coming from clinical trials; routine care; databases; registries, including clinical, cognitive, and advanced neuroimaging data; omics (genomics/transcriptomics/proteomics/metabolomics); and clot composition analysis should be shared across centers, collected using standardized methods and a high-quality big data approach, and made available as a fertile ground for future studies. Furthermore, the use of artificial intelligence could allow the development of algorithms that, if validated, may guide stroke physicians in more precisely tailoring decision-making processes regarding patient selection and prognosis determination for each individual patient. This obviously needs expertise and a multidisciplinary approach including stroke clinicians and both clinical and basic researchers, but also data scientists, omics specialists, biostatisticians for adopting and implementing adequate statistical methodologies, epidemiologists, computer scientists, engineers, and experts in advanced analytics and artificial intelligence. Multicenter collaborative efforts should be put in place through the establishment of consortia and of adequate infrastructure for a proper and standardized data collection. What is certain is that a philosophic and paradigm shift in the stroke community and a transition to a superior management level should occur because individualized treatments based on prognosis prediction models incorporating precision medicine-based variables represent the real challenge for the future and the next frontier.