Thrombolysis with alteplase (recombinant tissue plasminogen activator) administered within a narrow therapeutic window provides an effective therapy for acute ischaemic stroke. However, mainly because of prehospital delay, patients often arrive too late for treatment, and no more than 1—8% of patients with stroke obtain this treatment. The authors of this review suggest that all links in the prehospital stroke rescue chain must be optimized so that in the future a larger percentage of patients can profit from time-sensitive acute stroke therapy. Measures for improvement include continuous public awareness campaigns, education of emergency medical service personnel, the use of standardized, validated scales for recognition of stroke symptoms and for triaging to the appropriate institution, and advance notification to the receiving hospital. In the future, use of telemedicine technologies for interaction between the emergency site and hospital, and the strategy of treatment directly at the emergency site (concept of mobile stroke unit), could contribute to more efficient use of resources and reduce the time taken to initiate treatment to within 60 minutes of the onset of stroke symptoms.
Fassbender K, Balucani C, Walter S, Levine SR, Haass A, Grotta J: Streamlining of prehospital stroke management: the golden hour. Lancet Neurology 12(6): 585-596 (2013).
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