title: Hurdles in stroke thrombolysis: Experience from 100 consecutive ischemic stroke patients.
abstract: BACKGROUND
  Acute management of ischemic stroke involves thrombolysis within 4.5 h. For a successful outcome, early recognition of stroke, transportation to the hospital emergency department immediately after stroke, timely imaging, proper diagnosis, and thrombolysis within 4.5 h is of paramount importance.
  
  
  OBJECTIVE
  To analyze the obstacles for thrombolysis in acute stroke patients.
  
  
  METHODS
  The study was conducted in a tertiary care center in South India. A total of hundred consecutive patients of acute ischemic stroke who were not thrombolysed, but otherwise fulfilled the criteria for thrombolysis were evaluated prospectively for various factors that prevented thrombolysis. The constraints to thrombolysis were categorized into: i) Failure of patient to recognize stroke symptoms, ii) patient's awareness of thrombolysis as a treatment modality for stroke, iii) failure of patient's relative to recognize stroke, iv) failure of primary care physician to recognize stroke, v) transport delays, vi) lack of neuroimaging and thrombolysis facility, and vii) nonaffordability.
  
  
  RESULTS
  The biggest hurdle for early hospital presentation is failure of patients to recognize stroke (73%), followed by lack of neuroimaging facility (58%), nonaffordability (56%), failure of patient's relative to recognize stroke (38%), failure of the primary care physician to recognize stroke (21%), and transport problems (13%). Awareness of thrombolysis as a treatment modality for stroke was seen only in 2%.
  
  
  CONCLUSIONS
  Considering the urgency of therapeutic measures in acute stroke, there is necessity and room for improvement to overcome various hurdles that prevent thrombolysis.
authors.affiliation: Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
authors.forename: Sagar
authors.initials: S
authors.lastname: Badachi
authors.affiliation: Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mathew
authors.affiliation: Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
authors.forename: Arvind
authors.initials: A
authors.lastname: Prabhu
authors.affiliation: Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Nadig
authors.affiliation: Department of Neurology, St. John's Medical College Hospital, Bengaluru, Karnataka, India.
authors.forename: Gosala R K
authors.initials: GR
authors.lastname: Sarma
keywords: Hurdles; hurdles in acute stroke management; ischemic stroke; stroke thrombolysis