Expanding the range of therapies for acute ischemic stroke: the early experience of the Regional Stroke Center at Hartford Hospital.

PURPOSE: Three to four percent of all patients with acute ischemic stroke (AIS) receive the only FDA-approved therapy, intravenous tissue plasminogen activator. We sought to assess the impact of a regional stroke program, the Stroke Center at Hartford Hospital, in facilitating various therapies for patients with AIS, and their early outcomes. METHODS: For a 34-month period (May 2001 to February, 2004), 113 patients received either i.v. and/or intra-arterial thrombolysis, or an experimental protocol as a therapy for AIS. The Hartford Hospital and Stroke Center databases were queried for the diagnosis of AIS using ICD-9 codes, site of patient presentation, transportation modality, stroke severity, and clinical outcome. RESULTS: The percentage of patients with AIS treated has increased each of the past five fiscal years, to 15.4% for fiscal year 2004 to date. This growth is paralleled by increases in mean annual stroke severity of all stroke patients admitted to Hartford Hospital and in the numbers of patients transferred with AIS from other hospitals in southern New England. Symptomatic hemorrhage rate for the 113 patients was 5.3%. In-hospital mortality rate was 25.7%. Most patients (56.6%) were discharged from Hartford Hospital either to home or to acute rehabilitation. CONCLUSIONS: A regional stroke program greatly facilitated acute stroke treatment interventions. We attribute this growth to widespread educational programming, an Acute Stroke Team, catheter-based therapies with a dedicated Interventional Neuroradiology service, a 1800 Acute Stroke Hotline, and clinical trials.