Intravenous thrombolysis with rt-PA in stroke: experience of the moroccan stroke unit

Abstract

The majority of strokes are due to blockage of an artery in the brain by a blood clot. Prompt treatment with thrombolytic drugs can restore blood flow before major brain damage has occurred. We report the case series of all patients who were treated with rt-PA at Stroke Unit of HASSAN II University hospital between 2010 and 2013. There were 52 patients treated with intravenous rtPA during the study period. The mean age was 63 years with the no gender predominance (sex ratio 1.02). Hypertension was the most common vascular risk factor (31%) and 17% of patients suffered from atrial fibrillation. 17 of 52 patients (32.7%) were treated within a 3 hours window of stroke onset and 35 of 52 (67.3%) patients were treated within 3-4.5 h. Twenty five patients (48%) had significant early improvements within 24 hours and twenty one (40.3%) patients had good outcomes at 3 months and fifteen patients (29%) died within the same period.

Challenges of the Management of Stroke in Sub Saharan Africa: Evaluating Awareness, Access and Action

“…The predominant means of transport being commercial vehicles (taxi/cab) in Ghana. Local ambulance services were mostly used when patients were referred from another hospital [54]. Even in more advanced Morocco, this lack of ambulance services accounted for the delay of 120 min as against the SITS delay of 65 min [55].…”

“…A multi-site, hospital-based survey was conducted in 11 major referral hospitals from Ghana found acute stroke care by specialists, especially neurologists, in 36.4% [4] of the study hospitals [54]. Remarkably WHO recommendations is to reach at least the ratio of one neurologist for 50,000 people in a state, the fact in SSA is, in the "best" case, it is one for 500,000 (Ivory Coast and Senegal) [56].…”

“…Finally, the lack of stroke units all over SSA cannot be over emphasized. Few countries in Africa as a whole have stroke units; most have only one [54,55,59].…”

“…In the multisite study in Ghana [8] study sites reported having a brain computed tomographic (CT) scan, only [7] (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in 3) [54].…”

“…Stroke units are a rare luxury in SSA being only one in Ghana [54] with no provision of thrombolysis using tissue plasminogen activator for acute ischemic stroke care. Thrombolysis is not available and had never been prescribed in Burkina Faso [68].…”