Organizing regional networks to increase acute stroke intervention.

OBJECTIVES: Acute ischemic stroke is the second leading cause of death worldwide and the leading cause of adult disability in the United States (US). Thrombolytic therapy was proved effective, and approved for use, in the US by the Food and Drug Administration in 1996, yet 8 years later just 3-4% of stroke victims in the US are treated with tissue plasminogen activator. In order to understand how this figure can be substantially improved, it is important to evaluate the available therapies and systems of care, delineate the critical steps and the existing barriers in the process for successful intervention, and thoroughly understand the key components in the highly successful interventional stroke programs, especially regionalization of care. METHODS: A review of the available literature was carried out and interventional stroke data from the Mid America Brain and Stroke Institute at Saint Luke's Hospital (SLH) in Kansas City, Missouri, was analysed. RESULTS: There are several treatment strategies available for acute stroke intervention and more are likely to be developed. There is increasing interest in organizing and standardizing care for stroke. The steps in the process for successful intervention are understood and progress is being made in several areas of the country, but challenges remain in public education, directing emergency transport to 'stroke ready' hospitals and linking stroke experts to primary care providers. The Kansas City regional network linking primary care hospitals to the stroke team at SLH has been highly successful in substantially increasing the number of patients receiving acute stroke intervention. DISCUSSION: The stage is set for many more stroke victims to receive acute interventional therapy. However, these patients must present to hospitals equipped and staffed to render this therapy. Most stroke victims will go or be taken to the closest medical facility. Organizing regional networks linking primary care hospitals and physicians to comprehensive stroke centers staffed, and capable of providing the entire spectrum of acute stroke intervention will be essential in substantially increasing the number of stroke victims who actually receive acute interventional therapy. This article summarizes the evolving solutions to this challenge with specific data from the successful regional network developed around the Mid America Brain and Stroke Institute at Saint Luke's Hospital in Kansas City, Missouri, USA.