Utilization of acute vascular imaging and neurointervention for acute ischaemic stroke patients in 20 Hungarian stroke centers.

BACKGROUND AND PURPOSE: Acute mortality rate of stroke in Hungary is significantly higher than in Western Europe, which is likely to be partially attributable to suboptimal treatment. METHODS: We examined the use of acute vascular imaging and mechanical thrombectomy for acute ischaemic stroke patients. We collected data on 20 consecutive patients from Hungarian stroke centers before 31st August 2016. RESULTS: Out of the reported 410 patients, 166 (40.4%) underwent CT angiography and 44 (10.7%) had mechanical thrombectomy. CONCLUSION: Only about 1/3 of acute ischaemic stroke patients eligible for thrombectomy actually had it. The underlying reasons include long onset-to-door time, low utilization of acute vessel imaging and a limited neuro-intervention capacity needing improvement.

[Non-contrast brain ct based systemic thrombolysis of two wake up ischemic stroke patients in rural settings]. / Ébredési ischaemiás stroke esetek szisztémás thrombolysise natív koponya-CT-vizsgálatra alapozva egy vidéki kórházban.

Background and presentation - Conventionally the acute ischemic stroke patients who wake up with symptomes (WUS - wake up stroke) cannot benefit from systemic thrombolysis due to the uncertainty of the exact onset time of the cerebrovascular event. Perfusion brain imaging could be used as patient selection tool but the method is not available in many settings. Simple non-contrast CT scan is easily accessible and reliable as it shows the different stages of the evolving ischemia with high accuracy. Early brain CT scan results of WUS patients have the same characteristics as the ones who are surely within therapeutic window. The intravenous thrombolysis with recombinant tissue plasminogen activator (rTPA) of WUS patients seems to be similarly successful as the ones with known onset time, the treatment does not come with excess complications, higher rate of symptomatic intracranial hemorrhage was not found in previous reports. Purpose - In this report we present two systemic thrombolysis cases of acute ischemic stroke patients who woke up with stroke symptoms. Methods - In 2014 and 2015 we performed systemic thrombolysis for one wake up stroke patients, respectively. Both patients had large vessel occlusion. Indication was based on favourable non-contrast brain CT scan results. Results - Treatment of these two patients with rTPA proved to be safe, no hemorrhage occurred after treatment. Conclusion - We presented two acute ischemic stroke patients with symptomes at early wake up who were treated intravenously with recombinant tissue plasminogen activator based on non-contrast CT alone without complications and some moderate improvement at 90 days in the settings of a rural town hospital in a middle income country.

[Epidemiology of stroke in the elderly]. / Az idoskori stroke epidemiológiája.

BACKGROUND: In the industrialized countries the very old stroke patient is more frequent than before. For the time being Japanese people have the highest expected lifespan, so the epidemiological features of stroke in the very old can be examined here quite easily. From a few publications with low case number it is known that in this group of patients the statistical characteristics of stroke is remarkably different from the younger ones. SUBJECTS AND METHODS: The subjects aged 85 or more years were selected from the Akita Stroke Registry with first-ever acute stroke from 1996 to 1998. RESULTS: 8046 cases were recorded. There were 7362 patients aged <85 years, and 684 patients aged > or =85 years (8.5%). Sex ratio (women/men) was 1.89 in the two age groups. In the population of Akita the crude incidence of first-ever stroke was 222/100,000/year, and 1085/100,000/year in the very old, who were characterized with relatively lower prevalence of stroke risk factors, except that of atrial fibrillation (26.9%) and cardiac diseases (34.2%). The stroke subtype distribution (cerebral infarction 73.2%, intracerebral haemorrhage 20.6%, subarachnoidal haemorrhage 6.1%) was significantly different from the one known in Japan. Mortality rates were considerably high, especially in the SAH group. The most powerful prognostic factor of death was the level of consciousness at the onset. The next in the order of predicting value was the SAH subtype. CONCLUSION: While people aged 85 years or more had relatively lower prevalence of cardiovascular risk factors, they suffered stroke with very high frequency, the evolved cerebrovascular event caused very severe symptoms and led to death with high rate. Implicitly this is illuminating the complexity of aging as a process, furthermore it increases the importance of prevention, and even more of the care and rehabilitation of acute stroke in this old age group.