scholarly journals Shenzhen stroke emergency map improves access to rt-PA for patients with acute ischaemic stroke

2019 ◽  
Vol 4 (3) ◽  
pp. 115-122 ◽  
Author(s):  
Shisheng Ye ◽  
Shiyu Hu ◽  
Zhihao Lei ◽  
Zhichao Li ◽  
Weiping Li ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Acute Ischaemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Number Of Patients ◽  
Before And After ◽  
Geographical Disparity ◽  
Geographical Distances ◽  
Successful Approach ◽  
Emergency Systems

Prehospital delay is one of the major causes of low rate of intravenous recombinant tissue plasminogen activator (rt-PA) thrombolysis for acute ischaemic stroke in China. Regional emergency systems have been proven a successful approach to improve access to thrombolysis. Shenzhen is a high population density city with great geographical disparity of healthcare resources, leading to limited access to rt-PA thrombolysis for most patients with acute ischaemic stroke. To improve rapid access to rt-PA thrombolysis in Shenzhen, a Shenzhen stroke emergency map was implemented by Shenzhen healthcare administrations. This map comprised certification of qualified local hospitals, identification of patients with stroke, acute stroke transport protocol and maintenance of the map. We conducted a retrospective observational study to compare consecutive patients with acute stroke arriving at qualified local hospitals before and after implementation of the Shenzhen stroke emergency map. After implementation of the map, the rate of patients receiving rt-PA thrombolysis increased from 8.3% to 9.7% (p=0.003), and the rate of patients treated with endovascular thrombectomy increased from 0.9% to 1.6% (p<0.001). Sixteen of 20 hospitals have an increase in the number of patients with stroke treated with rt-PA thrombolysis. The median time between receipt of the call and arrival on the scene reduced significantly (17.0 min vs 9.0 min, p<0.001). In Shenzhen Second People’s Hospital, the median onset-to-needle time and door-to-needle time were reduced (175.5 min vs 149.5 min, p=0.039; 71.5 min vs 51.5 min, p<0.001). No statistically significant differences were found in the proportion of rt-PA-treated patients within various geographical distances. Currently, there are more than 40 cities in China implementing a stroke emergency map. The Shenzhen stroke emergency map improves access to rt-PA thrombolysis for acute ischaemic stroke, and the novel model has been expanded to multiple areas in China. Future efforts should be conducted to optimise the stroke emergency map.

scholarly journals A pragmatic approach to sonothrombolysis in acute ischaemic stroke: the Norwegian randomised controlled sonothrombolysis in acute stroke study (NOR-SASS)

BMC Neurology ◽  
2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Aliona Nacu ◽  
Christopher E. Kvistad ◽  
Nicola Logallo ◽  
Halvor Naess ◽  
Ulrike Waje-Andreassen ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Acute Ischaemic Stroke ◽  
Pragmatic Approach ◽  
Stroke Study ◽  
Randomised Controlled

Stroke thrombolysis in the very elderly

2010 ◽  
Vol 20 (4) ◽  
pp. 261-267
Author(s):  
Cora McGreevy ◽  
Alan Moore ◽  
Ciaran Donegan ◽  
David JP Williams
Keyword(s):  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Specific Treatment ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Evidence Base ◽  
Future Research ◽  
Very Elderly ◽  
Tissue Plasminogen ◽  
Neuroimaging Techniques

SummaryAcute ischaemic stroke is common in older people and is associated with a higher morbidity and mortality compared with younger patients. Intravenous thrombolysis with recombinant tissue plasminogen activator (r-tPA) has become the mainstay of treatment and is the only evidence-based specific treatment for acute ischaemic stroke. However, little data are available on the safety of thrombolysis in the over-80 years age group due to under-representation of this group in trials and the upper age limit for licensing of the drug. In this review, we look at the pathophysiology of stroke and recent advances in neuroimaging techniques. We also look at the evidence base for use of thrombolysis in stroke and in particular analyse the trials that include the very elderly as subjects. Finally, issues around ongoing trials and future research are discussed.

scholarly journals Clopidogrel resistance in stroke patients (The CRISP Trial)

2020 ◽  
Vol 11 (1) ◽  
pp. 1-5
Author(s):  
E Qazi, ◽  
Syed AH Zaidi ◽  
Olukolade O Owojori ◽  
LJ Bonnett ◽  
PR Fitzsimmons ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Acute Ischaemic Stroke ◽  
University Hospital ◽  
P Value ◽  
Clopidogrel Resistance ◽  
Appropriate Treatment ◽  
Unit Increase ◽  
Acute Stroke Unit

Objective: To investigate the incidence of clopidogrel resistance in patients with acute ischaemic stroke and to evaluate whether there is an association between clopidogrel resistance and the occurrence of a further cerebrovascular ischaemic event using the vasodilator-stimulated phosphoprotein (VASP) index as a marker of clopidogrel resistance. Methods: It is a prospective cohort study that recruited 120 patients from the acute stroke unit at the Royal Liverpool University Hospital. All patients with confirmed acute ischaemic stroke had clopidogrel 75mg/day at discharge or after 14 days of acute stroke if deemed by the direct clinical team to be the most appropriate treatment. After at least 7 days of clopidogrel 75mg/day, all those patients fulfilling inclusion/exclusion criteria had phosphorylation of vasodilator-stimulated phosphoprotein (VASP) measured. If VASP measured ≥50% after ≥7 days of clopidogrel maintenance, these patients were deemed as ‘clopidogrel resistant’, while those with VASP <50% were deemed as ‘clopidogrel responder’. Statistical analysis was by univariable analysis which considered the association of each variable – diagnosis, age, duration of clopidogrel, VASP, days to VASP, and number of comorbidities – with the outcome. Risk of second stroke after a first at 6, 12 and 24 months was estimated using logistic regression. Results: No variables were significantly associated with risk of stroke at 6 months with clopidogrel resistance having no significant effect on likelihood of a further stroke compared to the no clopiodgrel resistance cohort (p value= 0.39). Results were similar at 12 months follow up. However, at 24 months VASP index was significantly associated with risk of a further stroke; each one unit increase in VASP was associated with a 3% increase in risk of stroke at 24 months (p value = 0.05, CI Interval of 1.00- 1.06). Conclusion: No variables were significantly associated with risk of further stroke at 6 months and 12 months after a first stroke. However, VASP was significantly associated with risk of further stroke at 24 months with increasing VASP leading to a higher risk of further stroke.

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