title: How to improve ischemic stroke treatment in the fibrinolysis era.
abstract: In the last 15 years new therapeutic approaches have influenced the treatment of ischemic stroke victims. Aim of this review is to point out the elements of a modern approach to the acute stroke patient. The likelihood of saving ischemic cerebral tissue is time-dependent and the treatment goal is to minimise brain damage. The NINDS trial has documented a higher likelihood of better outcome if the fibrinolytic therapy is administered within 3 h of onset of symptoms. To reach this target several interventions are necessary. First of all, education is needed to diffuse public awareness of stroke warning signs. Moreover, out-of-hospital treatment should be optimised with rapid triage and transport to an hospital with a comprehensive stroke approach. The early hospital phase should comprehend a rapid evaluation and an urgent CT scan. After the verification of the inclusion/exclusion criteria, in a authorised SITS-MOST centre, the patient should receive fibrinolytic therapy. The diagnostic and the therapeutic phase should include rapid identification and treatment of secondary insults, as hyperthermia and hyperglycaemia, that have a negative influence on outcome. Despite advances in diagnosis and monitoring, fibrinolytic therapy is the only treatment with a proven efficacy in achieving a higher functional outcome. The narrow time-window is the reason for the need of rapid and well-organised out-of-hospital and in-hospital systems.
authors: Division of Neurology and Intensive Care, Department of Perioperative Medicine and Intensive Care, AO San Gerardo of Monza, Milan, Italy. g.citerio@hsgerardo.org
authors: G
authors: G
authors: Citerio
authors: D
authors: D
authors: Galli
authors: B
authors: B
authors: Cadore
authors: E
authors: E
authors: Rondelli
authors: F
authors: F
authors: Sala
authors: C
authors: C
authors: Abbruzzese