Thrombolysis in ischemic stroke: evaluation of operative difficulties

A few on-going international trials aim to investigate the effectiveness of early fibrinolytic treatment for ischaemic stroke to assist cerebral reperfusion. This operative strategy depends on clinical parameters such as haemorrhagic lesions, coma, pre-existent impairment and disability, and the efficiency of the sanitary organization receiving the patients (availability of CT scan, hospitalization within 6 h of onset of symptoms). We report data on the operative efficiency of a Regional Hospital Centre without a stroke unit: we observe that 142 patients did not receive early stroke treatment because of organizational problems whose prevalence exceeded the incidence of theoretical contraindications to fibrinolytic use. These elements suggest the necessity to organize a specific ward for the management of acute stroke.