Models and organizational pathways in the treatment of acute stroke

Abstract

Stroke due to its sudden and nefarious course is today considered “a medical emergency” that requires proper prevention and  adequate and time-depending treatment. To follow the adequate guidelines (AHA-ASA 2018 and ESO-ISO 2018), stroke treatment  involves the use of intravenous thrombolysis (IV) with Alteplase (or recombinant tissue plasminogen activator - r-tPA) within the first  4.5 hours of symptom onset and endovascular treatment within the first 6 hours if there were obstruction of large vessels such as the  intracranial internal carotid artery, the middle cerebral artery (M1-M2), the anterior cerebral artery (A1) , the basilar artery and the  tract intracranial vertebral artery. After the described options of treatment the hospitalization in the “Stroke Units” is fundamental.  This aspect, in the past largely undervalued, plays today a pivotal role in the patient’s “care”: continuous monitoring, combined with 
careful clinical observation, are, in fact, essential in order to both facilitate a faster possible rehabilitation of the patient , both to  prevent any complications and / or exacerbation of the disease (or the possible closure of the vessel). Aim of our lecture is to describe  the result of years of controlled clinical trials, which have allowed us to reach a good level of knowledge on the efficacy and safety of the various therapeutic aids, only mentioned above, and whose use is regulated in detail by the main Guidelines (LG) in force today,  including the Italian ISO-SPREAD LGs of 2016 [1] and the LGs produced by the American Heart Association (AHA), of which the American Stroke Association (ASA) represents a sector, and whose latest update is from 2018 [2].