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ARTICLE CONTRIBUTORS

Journal of the American College of Cardiology

News & Views

EARLY STROKE THERAPY DEMAND VERSUS SUPPLY

Although early reperfusion therapy for stroke is associated with better patient outcomes the majority of patients with acute ischaemic stroke (AIS) in the US do not receive any reperfusion therapy, according to a study1 published recently in the Journal of the American College of Cardiology.

Reseachers led by Dr Christopher J White (John Ochsner Heart and Vascular Institute, New Orleans) reviewed the currently recommended treatment algorithms for AIS.  The authors claim that timely reperfusion therapy for AIS has “embarrassingly lagged” behind that for acute myocardial infarction, due to a shortage of stroke neurologists, the narrow window for instituting therapy and the lack of high quality, prospective, randomised comparison trials to determine the safety and efficacy of interventional therapies.

They postulate that catheter-based therapies for AIS, including emboli removal devices, intra-arterial thrombolytics, and stenting, may improve rates of reperfusion without increasing the incidence of intracerebral haemorrhage.  None of these strategies are currently widely available, and they suffer from “a dearth of clinical trial data”, the authors claim.

Ultimately, they say, for AIS treatment to “catch-up” with that of AMI would require establishing national goals for stroke reperfusion therapy and national quality measures for “door to needle” and “door to intervention” times.  They recommend patient education to foster early presentation, expanding the number of hospitals and providers offering catheter-based treatments emergently, and a search for data to match patients with their best option for reperfusion therapy.  “Turf battles” should also be stopped, they assert, allowing recruitment from the pool of willing interventionalists with carotid stent experience “who must work together as a team to improve delivery of much-needed care to stroke patients”.

For all those interested in stroke medicine, keep the date:

6th UK Stroke Forum Conference 
29 November to 1 December 2011

http://www.ukstrokeforum.org/

References

1 White CJ, Abou-Chebl A, Cates CU, et al. Stroke Intervention: Catheter-Based Therapy for Acute Ischemic Stroke.  JACC 2011;58:101-16. doi:10.1016/j.jacc.2011.02.049.  

Published on: August 2, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association
 

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