Tomorrow, October 29, is World Stroke Day.
This year’s campaign focuses on the importance of timely stroke recognition and treatment, and the slogan # tempopreciousis more indicative than ever.
We delve into the issues of the pathology, today the first absolute cause of disability, and a third of the affected people who survive with a variable degree of residual disability, with the President Elect ISA-AII (Italian Stroke Association) Dr. Paola Santalucia, neurologist and medical director of the ASL.
Just yesterday, the ISA-AII launched the second appointment of the Strike on Stroke campaign at a press conference, in collaboration with A.LI.Ce (Association for the fight against Stroke).
Dr. Santalucia, what are the signs that a person needs to be aware of in order to recognize a stroke?
We can be in the presence of a stroke when there is only one of these signs: crooked mouth, heaviness in a limb, difficulty speaking, are the signs of the acronym FAST: Face (face), Arm (arms), Speech (language), Time (time). In the presence of even one sign you should not waste time, you must immediately call for help (112 or 118). The timeliness of the treatment is fundamental, in a single minute 2 million neurons are irreversibly lost, which represents the correlate of a specific function. In one hour, about 3 and a half years of the patient’s life are lost, and a total of 37 years of life are lost due to an untreated stroke.
Can stroke be cured? What is the treatment?
Yes, it is possible to treat stroke through specific treatments that are thrombolysis to be performed at most within 4 and a half hours of the onset of symptoms and mechanical thrombectomy at most within 6 hours of the onset of symptoms and in hyperselected cases an extension of the therapeutic window is indicated. In some cases the interventions are combined, both are sensitive to the passage of time, so the earlier they are performed and the more opportunities there are to recover lost function and reduce disability and in some cases even death.
Howis the network composed in Italy?
It is distributed throughout the territory and includes first-level centers (spoke), where thrombolytic therapy is performed, and second-level centers (hub), in which interventional neuroradiology is present and therefore the treatment of endovascular mechanical revascularization, i.e. mechanical thrombectomy. If the patient arrives at a spoke centre, he/she undergoes intravenous lytic thrombus treatment and can be transferred, on the basis of the clinical indication and selection based on neuroimaging, to a hub centre to undergo endovascular treatment, and then returned to the NUUs (Neurovascular Therapy Units) of the local hospitals.
With Dr. Maurizio Plocco, head of the UTN of Spaziani di Frosinone, we go into the details of the activity of ASL di Frosinone.
Howis the stroke network of the Asl of Frosinone organized?
It is characterized as a spoke, headquarters of first-level UTN, of the southern area network of the regional network that includes the Polyclinic of Tor Vergata in Rome as a hub center, where the patient is centralized from the entire provincial territory from 118 after an interview with the neurologist on duty of the UTN of Frosinone. Here at the SP of Spaziani di Frosinone, with a well-coded intrahospital path, the patient is subjected to the diagnosis indicated for acute stroke, then CT, AngioTac with perfusion study and, in indicated cases, Magnetic Resonance and thrombolytic therapy. If a thrombotic occlusion of a large intra-cerebral vessel is diagnosed, the patient is transferred to the reference regional hub for possible endovascular treatment of mechanical thrombectomy. The intravenous thrombus lysis procedure is performed within 45-60 minutes of the patient’s arrival at PS. Subsequently, he returned to Frosinone for admission to the UTN where he began the second phase, that of the treatment and diagnosis of stroke, with an early start of the rehabilitation path that will continue later in the dedicated facilities. The patient is taken care of at 360 degrees through multidisciplinary and multiprofessional management, to start the rehabilitation process of recovery of functions.
What are the data of the interventions?
In the last two years, on average, 150 annual thrombolysis procedures are carried out at our centre, with a mechanical thrombectomy being associated in about 30% of cases. Spontaneous brain hemorrhages not of neurosurgical interest are also hospitalized with a significant improvement in patient outcome, especially with less residual disability post-event, thus also improving direct and indirect social costs for families.
What are the future projects of the Asl of Frosinone?
We are working in harmony with the Lazio Region so that ours becomes second level, therefore a hub. With interventional radiology, on the activation of which the Company is proceeding, also thanks to the funding allocated by the Department of Health, we will be able to perform the entire stroke treatment and patients will no longer have to be moved to Tor Vergata.
