Although stroke episodes are the 2nd leading cause of death in Greece, treatment for this condition has lagged behind in our country, when compared to the USA and other European countries.
During the last few years, the Acute Stroke Center (ASC) is a fundamental element in the treatment of stroke episodes. All the studies and trials conclude that treatment in the ASCs saves 1 out of 3 people from death, and reduces the percentage of disability due to stroke, up to 25%.
Mediterraneo Hospital has a commitment to provide quality care to its patients. As a result to this principle, Mediterraneo Hospital, in 2014, it launched the 1st ASC (Acute Stroke Center) in Greece.
Mediterraneo’s ASC admits acute stroke patients from the greater Athens area. The patients receive the highest level of care, using the latest treatments and protocols offered in Northern European and American institutions.
How is the ASC organized?
- Rapid assessment – patients arriving at the hospital Emergency Department, will be rapidly assessed by the specialist team.
- Early treatment – using clot-busting drugs (thrombolysis)
- 24 hours a day, 7 days a week monitoring and physiological intervention in the stroke center
- a multidisciplinary specialist team on call 24 hours a day, 7 days a week. This includes a team of neurologists with experience in acute stroke incidents, in close collaboration with colleagues from fields such as, Interventional Neuroradiology, Neurosurgery, Vascular Surgery, Cardiology and Hematology, physiotherapists, and trained medical and nursing personnel.
Mandatory is the support provided by the advanced imaging systems of the CT, MRI and digital angiography machines.
Diagnosis and assessment
The patient with an acute neurological condition (probable stroke) on arrival to the ED (emergency department) is rapidly assessed by the stroke team for the presence of a stroke or a condition mimicking a stroke. A Head CT scan will help to determine the presence of a hemorrhagic stroke (due to a ruptured blood vessel, usually an artery) or an ischemic stroke (caused by a blocked artery).
Patients presenting an ischemic stroke in less than 4 hours from the onset will have immediate multimodal imaging with CT (CT angiography and CT perfusion) or MRI (diffusion/perfusion MRI and MR angiography), with the goal of determining the size and extent of the stroke, the presence and location of the blocked artery causing the stroke, and the amount of brain tissue at risk of infarction.
These patients will be treated in the ASC immediately with thrombolytic agents (clot-busting drugs) infused into a vein (intravenously). Selected patients will be offered endovascular treatment (intra-arterial thrombolysis and/or thrombectomy) and transferred to the angiography suite.
In some cases the effects are immediate – the stroke symptoms disappear, but even if no benefit is immediately obvious, we know that long term outcomes are better if this treatment has been administered.
It is important to point out that the sooner the patients arrive at the hospital, the greater the benefit of administering thrombolysis.
After 24-48 hours in the ASC, patients are usually transferred to ward beds with telemetry (continuous cardiac monitoring), where rehabilitation continues. An array of tests performed will help determine the etiology (cause) of the stroke and treatment for the secondary prevention (to avoid a new stroke).
The following parameters are continuously monitored in the ASC:
- changes in the patient’s neurological condition
- blood pressure
- heart rate (for the presence of arrhythmias)
- cardiac signs of ischemia
- oxygen levels in the blood
- changes in breathing patterns
Patients are then sent home or to a rehabilitation facility.
What happens when I leave the ASC?
Every patient will be discharged with their medical records prepared by the medical team, as well as copies of all the tests performed at the hospital. The medical diagnosis will concentrate on the cause of the stroke, what tests were performed and their results, what further tests are needed, the treatment administered, the patient’s nursing needs, and the patient’s functional status.
ACUTE STROKE CENTER
PUBLICATION OF GUIDELINES FOR THE TREATMENT OF STROKE
Heart Vessels and Brain