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2017 ; 25
(1
): 54
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The golden hour of acute ischemic stroke
#MMPMID28532498
Advani R
; Naess H
; Kurz MW
Scand J Trauma Resusc Emerg Med
2017[May]; 25
(1
): 54
PMID28532498
show ga
BACKGROUND: Acute Ischemic Stroke (AIS) treatment has been revolutionised in the
last two decades with the increasing use of Intravenous Thrombolysis (IVT) and
with the advent of Endovascular therapy (EVT). AIS treatment and outcome are time
dependant and time saving measures are being implemented at every step of the
treatment chain. These changes have resulted in lower treatment times
in-hospital, but it is unclear if this translates into more patients being
treated within 60 min of symptom onset - the Golden Hour. The clinical outcome of
IVT therapy in this patient group was our secondary outcome. METHODS: From 2009
onwards, systematic changes were made to the AIS treatment chain leading to a
dramatic decrease in Door-to-Needle (DTN) time. Analyses were performed on the
number of these treatments year on year and their clinical outcomes within the
Golden Hour at Stavanger University Hospital (SUS). RESULTS: Six-hundred and
thirteen patients were included; seventy-three were treated within the Golden
Hour. The percentage of total IVT treatments occurring in the Golden Hour rose
from 2.2% in 2009 to 14.5% in 2015 (p = 0.006) with a high of 18.3% in 2012 (p <
0.001). All of these patients had a Median NIHSS of 0 at discharge, irrespective
of age and pre-existing comorbidity. There was no incidence of any ICH and
in-hospital mortality was only 2.7% in this group. DISCUSSION: The time from AIS
symptom onset to treatment is filled with delays. Despite the inherence of some
delays,significant efforts on the part of the pre- and in- hospital treatment
chain have made IVT therapy within 60 min a possibility. The allocation and use
of resources in the setting of rapid AIS treatment is warrantedand yields
unprecedented results. CONCLUSIONS: Our study shows that improved treatment
routines led to an increase in the number of patients treated within the Golden
Hour. Treatment in the Golden Hour leads to excellent outcomes in all patients,
irrespective of age and pre-existing comorbidity.
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