Reperfusion therapy for ischemic stroke in the Russian Federation: Problems and promises

Abstract

Current technologies for treating ischemic stroke (IS) within the first 4.5 hours after its onset involve highly effective brain substance reperfusion techniques (thrombolytic therapy (TLT)) aimed at restoring blood flow in the affected vessel. There has been a substantial increase in the number of systemic TLT procedures after establishing stroke subdivisions as part of regional vascular centers and primary vascular departments in our country. In the past 5 years, the number of IS patients undergoing systemic thrombolysis has virtually risen 10-fold. In 2009–2013, the primary and regional centers of the Russian Federation performed 10,718 systemic TLT procedures mainly in patients with moderate stroke. The further increase in the number of reperfusion procedures in IS patients is hindered by the fact that they seek medical advice too late for acute cerebrovascular attack (ACVA) because the population has low medical knowledge (therefore education campaigns are so important for the population to increase its awareness of the signs of ACVA), prehospital delays and problems, poor organization of hospital admission (delays in diagnostic procedures).It is important that the patients should be admitted to specialized ACVA departments as soon as possible. According to the AHA/ASA guidelines, the time between admission and TLT initiation (door-to-needle time) should not exceed 60 minutes. The major factors influencing the door-to-needle time are as follows: the time between admission and neurological examination, that between neuroimaging and its results, that of examination of necessary laboratory findings, that between admission and transfer to an intensive care unit after computed tomography. One may identify the following quality indices of the procedures (necessary diagnostic, therapeutic, and other interventions), which negatively affect the safety and efficiency of TLT: errors in determining contraindications to reperfusion, noncompliance with the protocol of thrombolysis, and further patient monitoring.In terms of the available potential of the established stroke departments, it is absolutely real to increase the number of TLT procedures through active information campaigns among the population, which will contribute to the earliest admission of patients with ACVA to the specialized departments, and it is also necessary to make further organizational improvements of the healthcare system for stroke patients at its all stages.

Keywords

• thrombolytic therapy
• ischemic stroke
• early hospitalization
• delay in hospitalization