Prehospital stroke care: potential, pitfalls, and future.
OBJECTIVE
Tissue-type plasminogen activator is the only pharmacological treatment approved for acute ischemic strokes but is administered to less than 5% of the patients. Excessive prehospital and in-hospital delays and lack of stroke center coverage are major issues that negatively impact stroke care. New strategies are being developed and evaluated to increase the number of tissue-type plasminogen activator-treated patients.


RESULTS
Factors that limit rapid access to acute stroke care are discussed, including those influencing time intervals from stroke onset to hospital admission. We also describe strategies that hold promise to reduce prehospital delays and increase access to acute stroke treatment.


CONCLUSIONS
The shortening of prehospital delays requires education of patients and health professionals and optimization of transport strategies. Future developments may include video conferencing offering telestroke expertise, strategies (i.e. therapeutic interventions) that might help to treat acute stroke patients with tissue-type plasminogen activator, and prehospital selection of candidates for endovascular therapies.
Mazighi
Mikael
M
INSERM U-698, Clinical Research in Atherothrombosis and Denis Diderot University, France.
Derex
Laurent
L
Amarenco
Pierre
P
D004632:Emergency Medical Services / Q000592:standards* / Q000639:trends*; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D000071939:Stroke Rehabilitation; D017216:Telemedicine / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D010959:Tissue Plasminogen Activator