scholarly journals Ultraearly Intravenous Thrombolysis for Acute Ischemic Stroke in Mobile Stroke Unit and Hospital Settings

Stroke ◽  
2018 ◽  
Vol 49 (8) ◽  
pp. 1996-1999 ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Frederik Geisler ◽  
Aristeidis H. Katsanos ◽  
Janika Kõrv ◽  
Alexander Kunz ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Intravenous Thrombolysis ◽  
Mobile Stroke Unit

scholarly journals Benefits of stroke treatment delivered using a mobile stroke unit trial

2017 ◽  
Vol 13 (3) ◽  
pp. 321-327 ◽  
Author(s):  
Jose-Miguel Yamal ◽  
Suja S Rajan ◽  
Stephanie A Parker ◽  
Asha P Jacob ◽  
Michael O Gonzalez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Healthcare Utilization ◽  
Stroke Unit ◽  
Standard Management ◽  
Mobile Stroke Unit ◽  
Tissue Plasminogen

Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile stroke unit and standard management clinical outcomes, healthcare utilization, and cost-effectiveness in tissue plasminogen activator-eligible acute ischemic stroke patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 in mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective cluster-randomized (mobile stroke unit versus standard management weeks) comparative effectiveness study in tissue plasminogen activator-eligible patients. Outcomes Primary: Ninety-day mean utility-weighted modified Rankin scale. Coprimary: cost-effectiveness based on EQ5D quality of life and one year poststroke costs. Analysis Two-sample t-test and linear regression adjusting for covariates; incremental cost-effectiveness ratio and net benefit regression. Results As of March 2017, 288 tissue plasminogen activator-eligible patients have been enrolled (173 in the mobile stroke unit arm and 115 in the standard management arm). Two new centers start in early 2017 with target end of recruitment September 2019. Conclusion This is the first randomized study to test for disability, healthcare utilization, and cost-effectiveness of a mobile stroke unit. The progress of the study suggests that it is feasible. Management of tissue plasminogen activator eligible acute ischemic stroke patients by a mobile stroke unit could potentially result in less disability and healthcare utilization, and be cost effective. Mobile stroke units are very costly. This trial may determine if the fixed cost can be justified by a reduction in disability and healthcare utilization. Clinical Trial Registration NCT02190500.

scholarly journals Disentangling Sex Differences in Use of Reperfusion Therapy in Patients With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2332-2338
Author(s):  
Jeppe Mainz ◽  
Grethe Andersen ◽  
Jan Brink Valentin ◽  
Martin Faurholdt Gude ◽  
Søren Paaske Johnsen
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Time Delay ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy

Background and Purpose: Previous studies from local settings have reported that women with acute ischemic stroke have a lower chance of receiving reperfusion therapy treatment, including intravenous thrombolysis and thrombectomy, than men, but the underlying mechanisms of this disparity have not been identified. We aimed to examine sex differences in the utilization of reperfusion therapy focusing on all the phases of pre- and in-hospital time delay in a nationwide population-based cohort. Methods: This study was based on data from nationwide public registries. The study population included patients aged at least 18 years admitted with acute ischemic stroke using emergency medical services in Denmark dispatched after an emergency call in the period 2016 to 2017. Study outcomes included time delays from symptom onset to start of reperfusion therapy and use of reperfusion therapy. Data were analyzed using multivariable quantile regression and logistic regression. Results: A total of 5356 stroke events fulfilled the inclusion criteria. Women (26.6%) were less likely to receive intravenous thrombolysis than men (30.2 %), corresponding to an unadjusted odds ratio of 0.84 (95% CI, 0.74–0.95). In addition, women experienced a 20 minutes longer median time delay from stroke symptom onset to stroke unit arrival than men. Adjusting for onset-to-door time only appeared to have a limited effect on the sex differences in use of intravenous thrombolysis, whereas the odds ratio was 1.06 (95% CI, 0.93–1.21) when adjusting for age at stroke, stroke severity, and cohabitation status. No sex difference was observed for the use of thrombectomy. Conclusions: Women received less reperfusion therapy than men and had a longer time delay from symptom onset to stroke unit arrival, primarily due to a longer delay from symptom onset to emergency medical services call. These differences appeared to be due to the higher age and the higher proportion of women living alone at the time of the stroke.

Abstract TP357: BP Management on the Mobile Stroke Unit for Ultra-Early Treatment of ICH and Acute Ischemic Stroke

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Anne W Alexandrov ◽  
Tomas Bryndziar ◽  
Joseph Rike ◽  
Victoria Swatzell ◽  
Wendy Dusenbury ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Early Treatment ◽  
Stroke Unit ◽  
Mobile Stroke Unit

Abstract P354: Assessment of Phased Implementation of a Mobile Stroke Unit for Acute Ischemic Stroke Treatment

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Soraya Sanchez Molero ◽  
Cynthia Diaz ◽  
James Boozan ◽  
Michael F Stiefel
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Stroke Care ◽  
Tissue Type ◽  
Retrospective Case ◽  
Stroke Treatment ◽  
Mobile Stroke Unit ◽  
Significant Difference ◽  
The Impact

Introduction: The timing of administering tissue-type plasminogen activator (tPA) in patients with an ischemic stroke is directly related to clinical outcomes. The use of a mobile stroke unit (MSU) is a strategy to provide acute ischemic stroke assessment and treatment in a more rapid fashion compared to standard stroke transport and management. Our program initiated the use of a MSU in 2017 as a part of a phased implementation program. We sought to determine the impact of the MSU on the timing of stroke care in the region as it related to proximity to the hospital. Methods: We collected data during the first 9 months of 2017 on patients who were transported to the hospital as pre-hospital stroke alerts (PHSA) via conventional ambulance or via the MSU. Using a retrospective case-controlled design we compared process metrics associated with the phased implementation of the MSU with conventional pre-hospital stroke alerts as standard of care (SOC). Results: There was a total of 178 stroke alert patients; 72 in the MSU group and 106 in the PHSA group. 35 patients received tPA, 16 in the MSU, 19 in SOC. There was no significant difference in age, body weight, race, gender, and length of stay in the hospital in the two groups. The time from 911 call to arrival on scene was 12.06 min versus 20.4 min in the PHSA and MSU groups, respectively. Despite a longer time for arrival TPA administration for patients within a 5 miles radius of the hospital was 89 ± 25 mins in the SOC group and 78±12 mins in the MSU group (p=0.11). For 911 calls originating 10-20 miles from the hospital, the time for 911 call to tPA was 106 ± 23 mins in the PHSA group (n = 4) and 86 ± 2 mins in the MSU group (n = 4). Conclusion: Our initial results are comparable with previously reported data . Our data suggests the MSU may have a greater impact on reducing time to tPA for those further from the hospital or where transport time is delayed. The role of the MSU for non tPA patients such as mechanical thrombectomy, intracerebral hemorrhage and subarachnoid hemorrhage warrants further investigation.

scholarly journals Acute ischemic stroke care in Germany – further progress from 2016 to 2019

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Daniel Richter ◽  
Ralph Weber ◽  
Jens Eyding ◽  
Dirk Bartig ◽  
Björn Misselwitz ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Unit ◽  
Time Window ◽  
Treatment Options ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Main Diagnosis ◽  
Regional Variability ◽  
Pronounced Increase

Abstract Background Stroke Unit Care (SUC), intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are evidence-based treatment options for acute ischemic stroke (AIS). Using nationwide comprehensive administrative data from Germany, we recently reported nationwide development of AIS admissions, SUC rates, IVT rates and MT rates in Germany between 2010 and 2016. In this update paper, we analyze data on the further development of these data to 2019 after publication of time window extensions for recanalization therapies. Methods We considered all hospitalized cases with the main diagnosis of the ICD-10-GM code I63 (AIS) for the year 2019. We identified stroke therapies by using the corresponding Operating and Procedure Keys for IVT, MT and SUC out of the DRG statistics. Regional analyses are based on data from the 412 German administrative districts and cities. We compared the results with those from 2016. Results Number of hospitalized AIS patients showed a mild decrease in 2019 (n = 225,531) compared with 2016 (n = 227,687), with significant more AIS patients treated on a stroke unit in 2019 (n = 167,799; 74.4% vs. n = 164,270; 72.1%, p < 0.001). The rate of IVT further increased from 14.9% (n = 33,916) in 2016 to 16.3% (n = 36,745) in 2019 (p < 0.001). Similarly, the MT rate increased from 4.3% (n = 9795) in 2016 to 7.2% (n = 16,135) in 2019 (p < 0.001). There was still a high regional variability for MT (1.4 to 15.2%) according to the place of residence of the AIS patients. Conclusions In Germany, the rates of recanalization therapies in patients with AIS continued to increase from 2016 to 2019. Compared to IVT-rates and numbers, the respective data for MT procedures showed an even more pronounced increase.

Effect of Cardioembolic Etiology on Intravenous Thrombolysis Efficacy for Acute Ischemic Stroke

2016 ◽  
Vol 13 (3) ◽  
pp. 193-198 ◽  
Author(s):  
Sabrina Anticoli ◽  
Maria Cristina Bravi ◽  
Giovanni Perillo ◽  
Antonio Siniscalchi ◽  
Claudio Pozzessere ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intravenous Thrombolysis
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