Jesmo li spremni za intravensku trombolizu u liječenju akutnog moždanog udara u našoj regiji?

Acute stroke is the leading cause of disability in modern society. Early treatment is crucial to maximize the benefit of stroke intervention. Effective thrombolytic therapy is dependent on timely intervention and guidelines for the recommended use of recombinant tissue plasminogen activator therapy within 3 hours after onset of stroke symptoms. The aim of the study was to assess whether we are ready for the introduction of thrombolysis in our region. We investigated retrospectively the time from symptom onset to hospital arrival (delay time) for patients with acute stroke in our region. Medical histories of all patients admitted to the Department in 2006 with acute stroke symptoms were studied. Statistical analysis was performed by use of the SigmaStat (version 2.0) software. Study results showed that a very high rate of patients presented after 24 hours of stroke onset (35%); 15% of all acute ischemic stroke (AIS) patients arrived within 3 hours of stroke onset. Due to other exclusion criteria established, only 4% of all AIS patients were eligible for intravenous thrombolysis. Most patients arrived in the hospital too late to get maximum benefit from the emerging stroke therapies. This may be due to the failure to recognize signs and symptoms or the lack of awareness of the potential treatment benefits. Our further efforts should be focused on increasing public awareness of the stroke signs and symptoms and on reducing delay time.Akutni moždani udar je vodeći uzrok invalidnosti u današnjem društvu. Rano liječenje je bitno za što veću učinkovitost akutnog liječenja. Učinkovita tromboliza rekombiniranim aktivatorom tkivnog plazminogena ovisi o vremenu i preporukama da se provede unutar 3 sata od nastanka simptoma moždanog udara. Cilj ove studije bio je utvrditi jesmo li spremni za uvođenje trombolize u našu regiju. Retrospektivno se promatralo vrijeme od nastanka simptoma do dolaska u bolnicu (vrijeme kašnjenja) bolesnika s akutnim moždanim udarom. Promatrale su se povijesti bolesti svih bolesnika primljenih u bolnicu u 2006. godini. U statističkoj obradi primijenjen je program SigmaStat (verzija 2.0). Utvrđen je vrlo visok postotak (35%) bolesnika koji su došli nakon 24 sata od nastanka moždanog udara; 15% svih bolesnika primljenih s akutnim ishemijskim moždanim udarom (AIMU) došlo je unutar 3 sata. Uzimajući u obzir i ostale kriterije isključivanja samo je 4% svih bolesnika primljenih s AIMU moglo primiti sistemsku trombolizu. Većina bolesnika je stigla prekasno da bi imala maksimalnu korist od hitne terapije moždanog udara. Uzrok je možda nepoznavanje znakova i simptoma ili nedovoljna saznanja o korisnosti ovog liječenja. Potrebno je i dalje se truditi i poboljšavati poznavanje znakova i simptoma moždanog udara, kao i smanjiti vrijeme kašnjenja

Recommendations for Stroke Management 2006 Update

This article brings an update of the Recommendations for Stroke Management, first published in this journal in 2001. The Recommendations are consistent with the Recommendations of three European societies represented Iri the European Stroke Initiative: the European Stroke Council, the European Neurological Society, and the European federation of Neurological Societies, and are in concordance with the Guidelines of the American Heart Association/American Stroke Association Council on Stroke, approved by the American Academy of Neurology. The Recommendations have been endorsed by the Croatian Society for Neurovascular Disorders of Croatian Medical Association, Croatian Stroke Society, and University Department of Neurology, Sestre milosrdnice University Hospital, Reference Center for Neurovascular Disorders of the Croatian Ministry of Health

Preporuke za liječenje bolesnika s karotidnom stenozom

These are evidence based guidelines for the management of patients with carotid stenosis, developed and endorsed by Croatian Society of Neurovascular Disorders, Croatian Society of Neurology, Croatian Society of Ultrasound in Medicine and Biology, Croatian Society for Radiology, Croatian Society of Vascular Surgery and Croatian Society of Neurosurgery. They consist of recommendations for noninvasive screening of patients with carotid stenosis, best medical treatment and interventions such as carotid endarterectomy and stent placement based on international randomized clinical trials.U ovom članku objavljujemo preporuke za zbrinjavanje bolesnika sa stenozom karotidnih arterija, prihvaćene od Hrvatskoga društva za neurovaskularne poremećaje, Hrvatskoga neurološkog društva, Hrvatskoga društva za ultrazvuk u medicini i biologiji, Hrvatskoga radiološkog društva, Hrvatskoga društva za vaskularnu kirurgiju i Hrvatskoga društva za neurokirurgiju. Sastoje se od preporuka za neinvazivni probir bolesnika s karotidnom stenozom, preporuke za najbolje medikamentno liječenje te preporuka za intervenciju kao što je karotidna endarterektomija i postavljanje stenta, a zasnovane su na rezultatima internacionalnih randomiziranih kliničkih pokusa