Improving the Stroke Care System With Multilevel Cooperation: Shazam Hussain, MD, FRCP, FAHA


The director of the Cerebrovascular Center at Cleveland Clinic discussed areas within hospital care that need addressing to improve outcomes of patients with stroke.

"We have now primary stroke centers, thrombectomy stroke centers, comprehensive stroke centers. Still though, we want to make sure those systems are well-organized and those within those hospitals are paying attention to the fine details about how quickly we’re moving patients."

Over the past decade, stroke systems of care have experienced vast improvements in endovascular therapy, neurocritical care, and stroke center certification, in addition to the advent of innovations such as telestroke and mobile stroke units. Successful treatment for patients with stroke hinges mainly on rapid evaluation and an integrated care model that minimizes time from last well known to recanalization.

Previous research has shown that early administration of intravenous (IV) tissue plasminogen activator (tPA) can increase the likelihood of improved clinical outcomes among those with acute ischemic stroke (AIS).1 Early recanalization of the cerebral vasculature, particularly in the setting of emergent large vessel occlusion (ELVO), is one of the strongest factors associated with reperfusion and successful treatment of AIS. Senior author Shazam Hussain, MD, FRCP, FAHA, and colleagues recently conducted a retrospective analysis that explored whether ultra-early administration of IV tPA within 60 minutes of symptom onset for AIS due to ELVO is associated with a higher rate of recanalization.2

The results aligned with the findings of many other stroke studies, with higher rates of complete recanalization, better chance of early neurological improvement, favorable clinical outcomes, and lower mortality for those in the ultra-early group. Despite the advancements made in recent years, there are still several aspects of timely stroke care that need improvement, according to Hussain. Hussain, who is the director of the Cerebrovascular Center at Cleveland Clinic, sat down with NeurologyLive to discuss areas he feels need more emphasis on, especially within the prehospital setting.

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