The median door-to-needle times for tPA administration in stroke center EDs in the United States has exceeded 60 minutes with little improvement since the drug was first approved in the United States in Grotta JC.
Coronavirus Resource Center. Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy Continue. Twitter Facebook. This Issue. Views 4, Ferri FF. Stroke, ischemic.
In: Ferri's Clinical Advisor Know stroke brochure. National Institute of Neurological Disorders and Stroke.
National Heart, Lung, and Blood Institute. Acute stroke and transient ischemic attack TIA adult. Mayo Clinic. Steiger N, et al. Primary prevention of stroke. Hasan TF, et al. Diagnosis and management of acute ischemic stroke. Mayo Clinic Proceedings. Weinstein CJ, et al. Stroke, hemorrhagic. Cerebral aneurysms fact sheet. Transient ischemic attack.
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Carotid endarterectomy. Lal BK, et al. Carotid stenting versus carotid endarterectomy: What did the carotid revascularization endarterectomy versus stenting trial show and where do we go from here? Effects of stroke. American Stroke Association. Rehab therapy after a stroke. Three key steps to recover from stroke.
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Learn more. More to Explore. March 11, May 28, Neurothrombectomy for the treatment of acute ischemic stroke in patients. J Clin Neurosci ; Acute stroke intervention. The IA treatment extends the therapeutic window and provides an option for patients with contraindications for systemic thrombolysis treatment and for patients who failed intravenous thrombolysis 5 5.
Countless difficulties were encountered during the implementation of thrombolytic therapy at HBDF. The HBDF Neurology Unit functions with an attending physician, who is responsible for all emergencies and for the support of the neurology resident; the resident is responsible for attending to the patients that have already been admitted.
Thus, the volume of neurologic emergencies is very high, overloading the doctor on duty. This was one of the difficulties encountered during the implementation of the Stroke Protocol and early thrombolytic treatment. This issue could be resolved by the recruitment of another neurologist to share the workload. Another challenge was the absence of a common protocol, between the Neurology and Neurosurgery departments, for treating post-thrombolysis complications, such as intraparenchymal haemorrhage.
Table 3 shows other difficulties encountered during the implementation process. One of the difficulties described in previously reported studies is the challenge of reproducing clinical trial results in real-world conditions. When a clinical trial is conducted, a specialist is expected to be available, in conjunction with a multidisciplinary team and motivated staff within the stroke unit; this cannot be easily replicated in daily practice 7 7.
Stroke units in their natural habitat. Stroke ; Another reported issue was the difficulty in standardizing the procedures for acute stroke patients and improving the level of care for these patients 8 8. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition.
JAMA ; Despite the difficulties encountered during the implementation process, our results were similar to those published in the literature, when compared with other studies in developing countries. We evaluated studies conducted in Tel Aviv, Israel 9 9. Lessons learned from 2 years experience in intravenous thrombolysis for acute ischemic stroke in a single tertiary medical center. Isr Med Assoc J ; Outcomes of intravenous thrombolytic therapy for acute ischemic stroke with an integrated acute stroke referral network: initial experience of a community-based hospital in a developing country.
J Stroke Cerebrovasc Dis ; Curitiba acute ischemic stroke protocol: a university hospital and EMS initiative in a large Brazilian city. Among these studies, the mean patient age was similar to that for patients suffering strokes in our study mean age, 59 years.
As expected, all patients were predominantly male. Differences in the symptom-to-door time, door-to-needle time, and needle application time, were observed, with our results being longer than those reported in the other studies.
These differences highlight the need for educational programs for teaching people to recognize the signs and symptoms of stroke, and the need for better interaction between the emergency services team and the hospital team to optimize the door-to-needle time.
These guidelines recommended times between hospital admission and medical evaluation 10 min , hospital admission and end of cranial computed tomography CT 25 min , admission and cranial CT interpretation 45 min , admission and r-tPA infusion 60 min , and for the availability of a neurologist 15 min and a neurosurgeon 2 hours.
During our thrombolytic therapy implementation period, our door-to-needle time was longer than that recommended by the guidelines, confirming the need for better organization of the service.
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