Quality indicators in the treatment of acute ischemic stroke

Cerebrovascular diseases are a global medical and social issue because of the high morbidity, disability and mortality they cause. WHO announces 15 million new ischemic strokes per year globally, with 5 million associated deaths and 5 million patients left permanently disabled. Thrombolysis (TL) with tissue plasminogen activator (rt-PA) is currently an approved differentiated pharmacotherapeutic treatment of ischemic stroke (IS) in its acute phase. There is irrefutable evidence of better health results and efficient clinical management of ischemic strokes within an integrated therapeutic approach as a key factor for improving the functional outcome in stroke patients. Quality is one of the most widely discussed issues in the theory and practice of disease management. Strict compliance with the standards for ischemic stroke treatment is an indicator of high quality patient management

Endovascular treatment in acute ischemic stroke

 Stroke remains a major health care challenge worldwide and is the third leading cause of death and the leading cause of disability in developed countries. The management of acute ischemic stroke has advanced greatly over the past 20 years. Now the treatment of stroke can be describe with one word- variety.The current review is dedicated to the problems of endovascular treatment in acute ischemic stroke. The different methods of treatment, pros and cons of each of them, discussing the different options for the patients are presented.

One therapeutic challenge - acute stroke by occlusion on M1 portion of the MCA - case report

PURPOSE: To discuss the therapeutic possibilities for treatment of malignant infarction by occlusion on M1 portion of the MCA.MATERIAl AND METHODS: The study was performed in a 35-year-old patient with acute ischemic stroke and left sided hemiparesis one hour before hospitalization. Intravenous t-PA was performed regarding the inclusion/exclusion criteria by protocol.RESUlTS: By reason of progression of neurological deficit and loss of consciousness MRI was performed in the next 24 hours. On MRI and MRI angiography ischemic stroke with haemorrhagic transformation in the right MCA and dislocation on the left were seen. The patient was treated by decompressive craniectomy. A converse development of focal neurological symptoms to mild central left-sided hemiparesis was reported with present good results.DISCUSSION: The presentation of this clinical case shows that some of the patients with acute ischemic stroke may benefit from a decompressive craniectomy. The timing and indications for this potential lifesaving procedure are still debated, there are no well-defined selection criteria for performing the surgery in case of supratentorial infarctions