Are we ready for intravenous thrombolysis in acute stroke treatment in our region?

Acute stroke is the leading cause of disability in modern society. Early treatment is crucial to maximize the benefit of stroke intervention. Effective thrombolytic therapy is dependent on timely intervention and guidelines for the recommended use of recombinant tissue plasminogen activator therapy within 3 hours after onset of stroke symptoms. The aim of the study was to assess whether we are ready for the introduction of thrombolysis in our region. We investigated retrospectively the time from symptom onset to hospital arrival (delay time) for patients with acute stroke in our region. Medical histories of all patients admitted to the Department in 2006 with acute stroke symptoms were studied. Statistical analysis was performed by use of the SigmaStat (version 2.0) software. Study results showed that a very high rate of patients presented after 24 hours of stroke onset (35%); 15% of all acute ischemic stroke (AIS) patients arrived within 3 hours of stroke onset. Due to other exclusion criteria established, only 4% of all AIS patients were eligible for intravenous thrombolysis. Most patients arrived in the hospital too late to get maximum benefit from the emerging stroke therapies. This may be due to the failure to recognize signs and symptoms or the lack of awareness of the potential treatment benefits. Our further efforts should be focused on increasing public awareness of the stroke signs and symptoms and on reducing delay time.

Recommendations for the management of patients with carotid stenosis.

These are evidence based guidelines for the management of patients with carotid stenosis, developed and endorsed by Croatian Society of Neurovascular Disorders, Croatian Society of Neurology, Croatian Society of Ultrasound in Medicine and Biology, Croatian Society for Radiology, Croatian Society of Vascular Surgery and Croatian Society of Neurosurgery. They consist of recommendations for noninvasive screening of patients with carotid stenosis, best medical treatment and interventions such as carotid endarterectomy and stent placement based on international randomized clinical trials.