Cardiovascular care of patients with stroke and high risk of stroke: The need for interdisciplinary action: A consensus report from the European Society of Cardiology Cardiovascular Round Table.

Comprehensive stroke care is an interdisciplinary challenge. Close collaboration of cardiologists and stroke physicians is critical to ensure optimum utilisation of short- and long-term care and preventive measures in patients with stroke. Risk factor management is an important strategy that requires cardiologic involvement for primary and secondary stroke prevention. Treatment of stroke generally is led by stroke physicians, yet cardiologists need to be integrated care providers in stroke units to address all cardiovascular aspects of acute stroke care, including arrhythmia management, blood pressure control, elevated levels of cardiac troponins, valvular disease/endocarditis, and the general management of cardiovascular comorbidities. Despite substantial progress in stroke research and clinical care has been achieved, relevant gaps in clinical evidence remain and cause uncertainties in best practice for treatment and prevention of stroke. The Cardiovascular Round Table of the European Society of Cardiology together with the European Society of Cardiology Council on Stroke in cooperation with the European Stroke Organisation and partners from related scientific societies, regulatory authorities and industry conveyed a two-day workshop to discuss current and emerging concepts and apparent gaps in stroke care, including risk factor management, acute diagnostics, treatments and complications, and operational/logistic issues for health care systems and integrated networks. Joint initiatives of cardiologists and stroke physicians are needed in research and clinical care to target unresolved interdisciplinary problems and to promote the best possible outcomes for patients with stroke.

Telestroke in Catalonia: Increasing Thrombolysis Rate and Avoiding Interhospital Transfers.

OBJECTIVES: The study aimed to evaluate the impact of a telestroke network on acute stroke care in Catalonia, by measuring thrombolysis rates, access to endovascular treatment, and clinical outcome of telestroke patients in a population-based study. METHODS: Telestroke network was implemented on March 2013 and consists of 12 community hospitals and 1 expert stroke neurologist 24 h/7 day, covering a population of 1.3 million inhabitants. Rest of the population (6.2 million) of Catalonia is covered by 8 primary stroke centers (PSC) and 6 comprehensive stroke centers (CSC). After a 2-way videoconference and visualization of neuroimaging on a web platform, the stroke neurologist decides the therapeutic approach and/or to transfer the patient to another facility, entering these data in a mandatory registry. Simultaneously, all patients treated with reperfusion therapies in all centers of Catalonia are prospectively recorded in a mandatory and audited registry. RESULTS: From March 2013 to December 2015, 1,206 patients were assessed by telestroke videoconference, of whom 322 received intravenous thrombolysis (IVT; 33.8% of ischemic strokes). Baseline and 24 h NIHSS, rate of symptomatic hemorrhage, mortality, and good outcome at 3 months were similar compared to those who received IVT in PSC or CSC (2,897 patients in the same period). The door-to-needle time was longer in patients treated through telestroke, but was progressively reduced from 2013 to 2015. Percentage of patients receiving thrombectomy after IVT was similar in patients treated through telestroke circuit, compared to those treated in PSC or CSC (conventional circuit). Population rates of IVT*100,000 inhabitants in Catalonia increased from 2011 to 2015, especially in areas affected by the implementation of telestroke network, achieving rates as high as 16 per 100,000 inhabitants. Transfers to another facility were avoided after telestroke consultation in 46.8% of ischemic, 76.5% of transient ischemic attacks, and 23.5% of hemorrhages. CONCLUSIONS: Telestroke favors safe and effective thrombolysis, helps to increase the population rate of IVT, and avoids a large number of interhospital transfers.

Impacto de la activación del código Ictus en la eficacia del tratamiento trombolítico / Stroke code impact on the efficacy of thrombolytic treatment

FUNDAMENTO Y OBJETIVOS: La mayoría de los pacientes con ictus llega a los servicios de urgencias fuera de la ventana terapéutica para el inicio del tratamiento trombolítico. El Código Ictus (CI) ha demostrado su eficacia para reducir los tiempos de latencia en ensayos clínicos, pero se desconoce su eficacia en la práctica clínica diaria. El objetivo fue determinar la aplicabilidad del CI en la práctica clínica diaria y su impacto en la eficacia del tratamiento trombolítico con rt-PA.PACIENTES Y MÉTODO: Pacientes con ictus isquémico de la arteria cerebral media (ACM) tratados con rt-PA desde junio de 2000 a diciembre de 2001, divididos en 3 períodos de 6 meses. Se valoró la influencia de la activación del CI en los tiempos de latencia, recanalización arterial y evolución neurológica precoz. RESULTADOS: Se estudió a 48 pacientes. Se observó un incremento significativo en el número de pacientes tratados con rt-PA en los 3 períodos (4,8; 5,3; 8,0 per cent). Se produjo un acortamiento progresivo y significativo (p = 0,036) del retraso global en el tiempo de inicio de la fibrinólisis (de 161,4 a 130,0 min), fundamentalmente por reducción en el tiempo de llegada a urgencias (72,2 a 52,0 min; p = 0,05). La proporción de pacientes tratados con fibrinolíticos en los que se activó el CI aumentó con el tiempo (p = 0,032). La activación del CI redujo el tiempo de llegada a urgencias (p = 0,013) y el del inicio del tratamiento (p = 0,049), e incrementó el porcentaje de recanalización precoz (p = 0,027) y la probabilidad de una mejor evolución neurológica a las 48 h (p = 0,036). CONCLUSIONES: La activación del CI es muy útil en el tratamiento de la fase aguda del ictus: permite tratar con rt-PA i.v. a un mayor porcentaje de pacientes y de forma más precoz, lo que se traduce en una mejor evolución clínica de estos pacientes (AU)