U.O. Neurologia – Stroke UnitU.O. Neuroradiologia – Modulo Dip. Neuroradiologia Interventistica

Dipartimento Neuroscienze - Riabilitazione

Corsia d’ospedale: anni ‘60

Courtesy of Prof. V. Toso

StrokeUnit

…despite an increased incidence of symptomatic intracerebralhemorrhage, treatment with intravenous tPA within three

hours of the onset of ischemic stroke improved clinicaloutcome at three months.

Unit Unit SettingSetting: : StrokeStroke UnitUnit

• Treatment at a Stroke Unit compared to treatment in a general ward

– reduces mortality (ARR 3%)

– reduces dependency(ARR 5%)

– reduces need forinstitutional care (ARR 2%)

• All types of patients, irrespective of gender, age, stroke subtype and stroke severity, appear to benefit from treatment in stroke units

Stroke Unit Trialists' Collaboration Cochrane Rev (2007)

Già autorizzato l’uso entro 4,5 ore in Germania e Regno Unito

Imminente l’approvazione AIFA

…… e oltre le 4,5 ore?e oltre le 4,5 ore?

Interpretation

“…despite the early hazard, thrombolysiswithin 6 hours improved functional outcome.

Benefit did not seemto be diminished in elderlypatients.”

Alive and Independent at Day 90Alive and Independent at Day 90Adjusted odds ratio (95% CI) by stroke onsetAdjusted odds ratio (95% CI) by stroke onset

to treatment timeto treatment time

ECASS IIIECASS IIISITSSITS--MOSTMOST

NN

T 9

NN

T 1

4

“Having more time does not mean physicians can take more time”

NN

T 3

IST III

NN

T 3

4

Trattamenti in acuto Trattamenti in acuto –– StrokeStroke UnitUnit FerraraFerrara

0

10

20

30

40

50

60

2005 2006 2007 2008 2009 2010 2011 2012

IA

EV

53

205

5% di tutti gli 5% di tutti gli ictusictus

OUTCOME a 3 mesiOUTCOME a 3 mesipz trattati con trombolisi ev

61

55

50

40

28

31

33

46

11

14

17

14

0% 20% 40% 60% 80% 100%

Ferrara

SITS Europa

tPA metanalisi

placebo

mRS 0-2 mRS 3-5 Morti

Limiti trombolisi ev

• Finestra temporale rigida

• Numerosi criteri di esclusione

• Basso tasso ricanalizzazione in occlusione grosso vaso

• Rischio emorragico sistemico

Basso tasso pztrattabili/tot. ictus

… oltre la trombolisi evStudio penombra ischemica in acuto e …

... ... ricanalizzazionericanalizzazioneendovascolareendovascolare

www.registroendovascolare.it