Interactions Within Stroke Systems of Care

Drip and Ship Thrombolytic Therapy for Acute Ischemic Stroke

“…Даже с учетом того, что этот метод являет-ся единственным одобренным методом лечения инсуль-та, частота проведения системного тромболизиса среди всех пациентов с ИИ остается чрезвычайно низкой [2]. Во многих небольших клиниках нет возможности про-водить обследование и мониторинг состояния пациентов с инсультом [3]. Кроме того, низкая частота проведения системного тромболизиса может быть обусловлена отсутст-вием в клиниках нейрохирургических отделений или отде-лений нейрореанимации, в которых проводят лечение осложнений после в/в введения ТАП, например симптом-ного внутричерепного кровоизлияния (сВЧК) [4].…”

“…2 In many small-to medium-sized hospitals, the infrastructure required for the ongoing evaluation and monitoring of patients with post-tPA stroke may not be available. 3 In addition, the absence of neurointensive or neurosurgical resources to manage post-tPA complications, such as symptomatic intracranial hemorrhage (sICH), may result in lower rates of tPA use. 4 The drip and ship method, whereby tPA is administered locally in an emergency department followed by transfer to a stroke center, aims to increase the rates of tPA use and its timely administration.…”

Effect of Telestroke on Emergent Stroke Care and Stroke Outcomes

“…24,25 The 2013 American Stroke Association (ASA) policy statement on Interactions Within Stroke Systems of Care recommends the use of telemedicine for NIHSS assessment of patients with stroke, with the results comparable with those of inpatient assessment (class I recommendation; level of evidence A). 26 The evaluation of acute stroke brain imaging is fundamental to proceeding with stroke thrombolysis. Multimodal brain imaging (eg, computed tomographic [CT] perfusion and CT angiography) is increasingly influencing clinical decision making, but the DICOM image files generated are large and require file compression algorithms and high-speed broadband capacity.…”

“…Efficient PACS teleradiology systems are a critical component within any telestroke system of care. 11,26 High levels of agreement in the teleradiology review of acute stroke brain imaging can be achieved. A study undertaken within a stroke telemedicine network in Arizona demonstrated an overall excellent agreement (91%) about the presence or absence of CT contraindications to thrombolysis between hub and spoke neuroradiologists and neurologists.…”

Role of Anesthesia for Endovascular Treatment of Ischemic Stroke

“…Current American Heart Association guidelines 32 do not recommend a preference for CS, monitored anesthesia care, or GA for acute ischemic stroke undergoing endovascular treatment; rather, they recommend timely, rapid, and coordinated intervention among the systems of care. 51 We suggest an individualized approach to decide whether to use GA or CS in this clinical setting (Figure).…”