title: Acute reperfusion therapy and stroke care in Asia after successful endovascular trials.
abstract: The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, ≈9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute stroke care, such as the dosage of alteplase for thrombolysis and consideration of bleeding complications during antithrombotic therapy. Acute endovascular thrombectomy, as well as intravenous thrombolysis, is relatively prevalent in East Asia, but most of the other Asian countries need to develop their human resources and fundamental medical infrastructure for stroke care. A limitation of endovascular therapy in East Asia is the high prevalence of intracranial atherosclerosis that can cause recanalization failure and require additional angioplasty or permanent stent insertion although intracranial stenting is not an established strategy. Multinational collaboration on stroke research among Asian countries is infrequent. Asians should collaborate to perform their own thrombolytic and endovascular trials and seek the optimal strategy for stroke care specific to Asia.
authors.affiliation: From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan. toyoda@ncvc.go.jp.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.affiliation: From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.affiliation: From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Mikito
authors.initials: M
authors.lastname: Hayakawa
authors.affiliation: From the Department of Cerebrovascular Medicine (K.T., M.H.), Division of Stroke Care Unit (M.K.), and Department of Neurology (H.Y.), National Cerebral and Cardiovascular Center, Suita, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamagami
mesh_terms: D002986:Clinical Trials as Topic; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards / Q000639:trends; D057510:Endovascular Procedures; D005202:Asia, Eastern; D005247:Feeding Behavior; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D002537:Intracranial Arteriosclerosis / Q000453:epidemiology / Q000628:therapy; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000628:therapy; D008019:Life Style; D015424:Reperfusion; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D017131:Thrombectomy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Asia; anticoagulants; cerebral hemorrhage; intracranial atherosclerosis; stroke; thrombectomy; thrombolysis, therapeutic