Page 88

Karger_ESC London_2013

22. European Stroke Conference 8:30-10:00 Oral Session Room 2,3,4 Acute stroke:emergency management, stroke units and complications A Chairs: A. Grau Germany and N. Venketasubramanian, Singapore 1 Acute stroke: emergency management, stroke units and complications A 8:30- 8:40 Results of the Federal Anti-stroke Program in the Russian Federation N.A. Shamalov1, L.V. Stakhovskaya2, G.E. Ivanova3, K.V. Shekhovtsova4, S.C. Lee5, V.I. Skvortsova6 Institute of Cerebrovascular Pathology and Stroke of the Russian National Research Medical University, Moscow, RUSSIAN FEDERATION1,Institute of Cerebrovascular Pa-thology and Stroke of the Russian National Research Medical University, Moscow, RUSSIAN FEDERATION2, Institute of Cerebrovascular Pathology and Stroke of the Russian National Research Medical University, Moscow, RUSSIAN FEDERATION3, Institute of Cerebrovas-cular Pathology and Stroke of the Russian National Research Medical University, Moscow, RUSSIAN FEDERATION4, Institute of Cerebrovascular Pathology and Stroke of the Russian National Research Medical University, Moscow, RUSSIAN FEDERATION5, Institute of Cere-brovascular Pathology and Stroke of the Russian National Research Medical University, Mos-cow, RUSSIAN FEDERATION6 Background. The Federal anti-stroke program (FASP) was started in the Russian Federation (RF) since 2008. The aim of our study was to assess the results of implementation of FASP in terms of mortality, functional outcome, rates of hospitalization and reperfusion therapy (RT). Methods. In 2008 – 2011 the network of primary and comprehensive stroke units (SU) was cre-ated. All consecutive patients who were hospitalized to SUs within 21 days after the stroke on-set were included in internet-based hospital registry. Mortality rate and number of patients with favorable outcome (mRs score 0-2) at day 30 during 2008-2011 were assessed as well as the rates of hospitalization to SUs and IV rt-PA were calculated. Results. In all regions of the RF 155 primary and 59 comprehensive stroke units (SU) were organized with all possibilities for acute stroke care, available CT and vascular ultrasound for 24 hs, neurorehabilitation with multidisciplinary approach including early mobilization and swallowing assessment, speech therapy, physiotherapy, kinesiotherapy, cognitive rehabilitation. The rate of hospitalization to SUs increased to 87.3%. The mean mortality rate decreased from 24.1% to 21.5%. The favorable outcome rate is 55%. RP was implemented in the most of SUs, the mean rate of IV rt-PA is 2.5% of all ischemic stroke patients (ranged from 0 to 15% in some centers). Significantly reduced door-to-needle time was observed after FASP started. Conclusion. Implementation of the Federal anti-stroke program dramatically changed the man-agement of stroke patients in the Russian Federation. Results of reorganization of stroke care system with multidisciplinary approach allowed decreased mortality and improved functional outcome after stroke. 2 Acute stroke: emergency management, stroke units and complications A 8:40 - 8:50 Telestroke network between 4 primary care centers: impact on thrombolysis delivery I. GIRARD BUTTAZ1, F. Mounier-Vehier2, T. Rosolacci3, J.L. BAUDET4, P. DALINVAL5, C. CORDONNIER6 on behalf of TELEAVCHA group CH Valenciennes, Valenciennes, FRANCE1,CH Lens, Lens, FRANCE2, CH Maubeuge, Maubeuge, FRANCE3, ACCELIS VEPRO, Valbonne, FRANCE4, Agenre Régional de Santé Nord Pas de Calais, Lille, FRANCE5, Lille University Hospital, Lille, FRANCE6 BACKGROUND: Stroke therapy is a time-critical disease process and the relative paucity of stroke specialists makes telestroke an attractive technique. The Hainaut-Artois is a rural region in the North of France covered by 3 primary care stroke centers that delivered rtpa to 190 pa-tients in 2010. We aimed to describe the effect of a telestroke network on the thrombolysis rate in this population of 1.65 million inhabitants. METHODS: In June 2011, a telestroke network was launched between 3 primary stroke centers (Valenciennes, Lens, Maubeuge) to cover non working times. In April 2012, one primary care hospital (Cambrai) without neurologist joined the network. Our prospective cohort describes the characteristics and 3-month outcome of the thrombolysis patients treated via the telestroke network. RESULTS: In 2012, 525 consecutive telestroke consultations were performed, 57% of which had been prenotified by the emergency medical service (EMS). 102 (19%) patients median age 74 years (IQR 61 to 84) received iv rtpa. The median NIH Stroke Scale score was 10 (IQR 6-14). The median door to treatment time (DTTT) was 75 minutes (IQR 62-90). High level notification by EMS had a strong impact on the decision to thrombolyse (RR 2.8; 95%CI 1.7- 4.5). The rate of symptomatic intracranial bleedings was 3%. 3 months after stroke: 50% of the thrombolysis patients with complete follow-up data had a favorable outcome (mRS 0-2) and 42% had an excellent one (mRS 0-1). In this population of 1.65 million inhabitants, the total number of patients thrombolysed in 2012 was 283 (102 with telestroke and 181 onsite) repre-senting a significant increase of 49% compared to 2010. CONCLUSIONS: Developing of a telestroke network between 4 local hospitals has significant-ly increased the number of patients treated with rtpa with an excellent safety and efficacy. In-creasing stroke awareness, reducing DTTT and extending to other primary care centers without neurologist on sites are our next challenges. 88 © 2013 S. Karger AG, Basel Scientific Programme


Karger_ESC London_2013
To see the actual publication please follow the link above