American Heart Association

World Stroke Day

World Stroke Day: The Long Journey of Revascularization Treatments for Ischemic Stroke: From Strict Patient Selection to Extending Time Windows

Raffaele Ornello, MD

Until the early 1990s, stroke was regarded as a disabling event with no cure. The NINDS trial of intravenous thrombolysis, published in 1995, changed the minds of stroke physicians and marked the rise of revascularization treatments for acute ischemic stroke. The initial criteria for patient selection were very strict. After that, more and more refined protocols were established, allowing the progressive extension of the therapeutic window and the loosening of selection criteria.

The last decade saw the rise of endovascular treatments. After the first unsuccessful trials, adequate protocols for the selection of patients with salvageable brain ischemic tissue led to success in recanalization treatments. Better use of brain neuroimaging led to refinements in patient selection, allowing the extension of time windows for treatments in eligible patients. Over the years, revascularization treatments for ischemic stroke spread over most hospitals in the world, allowing widespread access to treatments.

World Stroke Day: Interview with Dr. Anna Bersano on the Impact of the COVID-19 Pandemic on Stroke Care in Italy

Dr. Anna Bersano
Dr. Anna Bersano

An interview with Dr. Anna Bersano, MD, PhD, at the Cerebrovascular Unit of Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy, about the impact of the COVID-19 pandemic on stroke care in Italy.

Interviewed by Francesca Tinelli, MCs, rare cerebrovascular disease fellow at Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.

Dr. Tinelli: First of all, I present you Dr. Anna Bersano, the neurologist I work with, and I would like to thank Anna for agreeing to do this interview. 

Anna is a stroke neurologist with long-term expertise in cerebrovascular diseases, particularly in genetics of monogenic and complex stroke diseases, combining research with an active practice as a vascular care neurologist. She coordinated several studies on genetics of stroke, such as the Lombardia GENS study on stroke monogenic disease and the SVE-LA study on genetics of small vessel disease and lacunar stroke. Recently, she implemented an Italian network for the study of Moyamoya disease named GE-NO-MA (Genetics of Moyamoya Disease) and an Italian network for the study of Cerebral Amyloid Angiopathy (SENECA project). 

Dr. Bersano: Thank you for discussing this relevant and critical topic in the current situation.

Dr. Tinelli: What is the correlation between SARS-CoV2 and cerebrovascular diseases?

Dr. Bersano: It is well known that SARS-CoV2 invades human respiratory epithelial cells through its S-protein and ACE2 receptor on human cell surface. Then, the virus can spread from the respiratory tract to the central nervous system, causing possible neurological complications. A recent study on 214 Chinese COVID-19 patients reported acute cerebrovascular events in 5.7% of COVID-19 patients. However, the exact relationship between SARS-CoV2 and stroke is unclear. Patients affected by COVID-19 have been observed to have a higher risk of cerebrovascular events, probably due to the activation of coagulation and inflammatory pathways, which lead to cardiovascular and thrombotic complications, or to cardioembolic causes.

World Stroke Day: #DontStayAtHome: Stroke Symptoms Awareness Among Young Adults — Education is Key

Victor J. Del Brutto, MD

Mszar R, Mahajan S, Valero-Elizondo J, Yahya T, Sharma R, Grandhi GR, Khera R, Virani SS, Lichtman J, Khan Su, et al. Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults. Stroke. 2020.

Stroke is a devastating disease with potentially catastrophic consequences to its victims and their families. In the acute setting, immediate specialized evaluation and rapid delivery of time-sensitive therapies are crucial to improve the chances of a meaningful neurological recovery. Stroke systems of care across the world work daily in maximizing their treatment times in order to save neurons. However, time from symptoms onset to hospital arrival mainly depends on community awareness of stroke warning signs and the emergent response to stroke-like symptoms when they are perceived.

The World Stroke Day observed annually on October 29 was launched in 2006 with the main goal of raising awareness of the prevention and treatment of stroke. Mszar and colleagues bring us a timely analysis on the association between sociodemographic characteristics and disparities in awareness of stroke symptoms among U.S. young adults, a population group that has shown increasing trends in stroke incidence and stroke-related hospitalizations during the last few decades.

World Stroke Day: Stroke Care Advances in Armenia

David Sahakyan, MD
General and Endovascular Neurosurgeon, Head of Cerebrovascular Neurosurgery Service, Erebouni Medical Center, Yerevan, Republic of Armenia

Stroke is the primary worldwide healthcare problem, especially for developing countries. Armenia was one of those countries, where the implementation of modern, time-sensitive stroke treatment modalities like intravenous thrombolysis and mechanical thrombectomy was insufficient and sometimes impossible due to the high cost and underdeveloped stroke care system. For years, neurologists and neurosurgeons willing to provide state-of-the-art treatment to stroke patients were unable to do so because patients and their families had to pay for the procedures and medications out of their pocket before the treatment could be delivered. 

Everything changed in 2019. A collective effort of stroke specialists from Armenia and abroad, combined with the willingness of the new government to recognize the disability burden imposed by this devastating disease, led to amazing transformations in stroke care for the entire country. A national stroke program developed by a group of stroke specialists from the United States, Canada, France, and Armenia and supported by governmental funding made modern acute stroke care accessible for everyone in need in Armenia. In a small country with a population of 3 million, out of 5000 annual ischemic stroke patients, more than 300 patients have received acute stroke treatment for free since the beginning of 2019. More than 240 intravenous rTPA and 120 endovascular thrombectomies have already been performed at two stroke centers. In patients who received treatment, marked reduction of morbidity and mortality was achieved. It is worth mentioning that the budget of the program is around $1 million US dollars. And this is just the beginning. Further development of the stroke network is on the way.

Armenia is an excellent example of how a small developing country with limited financial resources can develop a world-class stroke care system with the help of experienced specialists from developed countries, motivated local physicians, and a supportive government.   

World Stroke Day: October 29

Richard Jackson, MD

This is an exciting time for the acute treatment of ischemic strokes with innovations in thrombectomy and advancements in imaging-based tissue evaluation for thrombolysis. Yet the percentage of patients being treated with these advancements remains low at around 15%. The treatment of ischemic cerebral disease is following in the footsteps of ischemic cardiac disease with the creation of hospital-led evidence-based programs and regional treatment programs involving primary and comprehensive stroke centers collaborating with local EMS providers. 

However, as the director of a primary stroke center, I am continually surprised by the delays in presentation to the hospital for care. I remember, as an intern on the telemetry rotation, admitting what seemed like a never-ending amount of chest pain patients for evaluation. Every night on call for stroke, I, like all neurologists, face questions regarding the disposition of patients with resolved symptoms, patients with delayed presentation to the emergency room, patients not wanting to come into the hospital for treatment, and the questions surrounding acute treatment. These nights, I am always left wondering, what has cardiology done better than neurology? Why don’t people in the community present for evaluation at the slightest possible acute cerebral insult? Is it that our treatments and programs need time to create the system they have, or do we need to do more on the community education programs?

NASAM Stroke Games 2019 and Stroke in Malaysia

Lin Kooi Ong, PhD

The National Stroke Association of Malaysia (NASAM) Stroke Games 2019, an amazing event showcasing remarkable possibilities of #LifeAfterStroke, kicked off with an inspiring start at the Panasonic National Sports Complex in Malaysia on October 19. This event is in conjunction with the World Stroke Organisation – World Stroke Day, Southeast Asia Route. Over 800 participants from different states, including Penang, Sabah and Johor, as well as Singapore, participated in 25 events. The youngest athlete was 16 years old, and the oldest was 81 years old. The games kicked off with seated volleyball and hand cycle. The event closed on October 20 with Janet Yeo, stroke survivor and founder chairman of NASAM, putting out the flame.

The NASAM Stroke Games 2019 was declared open.
The NASAM Stroke Games 2019 was declared open. Left to right are: Dato’ Wan Hashimi Albakri, Acting Group CEO, Sime Property Berhad; Tun Jeanne Abdullah, Patron of the Malaysian Paralympic Council; Janet Yeo, NASAM Founder Chairman; Hannah Yeoh, Deputy Minister, Ministry of Women, Family and Community Development; Stuart Milne, CEO, HSBC Bank Malaysia Berhad; Toh Puan Dato’ Seri Hajjah Dr Aishah Ong, Patron of NASAM; and Ruchira Gupta, NASAM Senior Advisor. Photo provided by Frankie Goh, NASAM, with permission.

“The Games is NASAM’s contribution to the stroke community around the world,” said Yeo. “We wish that this fighting spirit of a stroke champion is ignited into every person affected by a stroke no matter where they are.”

World Stroke Day: Staying Above the Fray

Burton J. Tabaac, MD

Join the fight against stroke!

In 2015, the World Stroke Campaign focused on raising awareness of stroke prevention and risk among women using the tagline “I am Woman – Stroke Affects Me, Stroke Affects Everyone.” In 2016, World Stroke Day was marked by recognizing that although stroke is a complex medical issue, there are ways to significantly reduce its impact. The World Stroke Organization built a campaign to underscore that “Stroke is Treatable.” The World Stroke Day 2017 campaign focused on risk awareness and prevention. Last year, World Stroke Day 2018 emphasized that there are resources and a network to assist those who have suffered from stroke, underscoring that you are not in it alone. #UpAgainAfterStroke was used as a rallying cry to inform the public about the well-developed network for caregivers, families, and friends affected by stroke who can help their loved ones.

This year, 2019, calls attention to prevention.

World Stroke Day and the Global Burden of Stroke: Miles to Go Before We Sleep

Abbas KharalAbbas Kharal, MD, MPH

The global burden of stroke continues to increase as stroke still remains amongst the highest causes of morbidity and mortality worldwide. Per the 2013 global burden of disease (GBD) report1, a greater than 3-fold increase in the burden of stroke was reported over the past two decades. A total of 11.6 million incident ischemic stroke cases were reported worldwide in the past two decades, of which one third occurred in those less than age 65, thus adding significantly more to the disability adjusted life years (DALYs) and economic burden of stroke worldwide. Beyond DALYs lost, stroke also has a large physical, psychological, and financial impact on the millions of patients affected, their families, the health care system, and the society at large, therefore suggesting that the true global burden of ischemic stroke is perhaps much more than what we measure it to be2,3.

Increasing Stroke Awareness and Care: Moving in the Right Direction

Danielle de Sa BoasquevisqueDanielle de Sa Boasquevisque, MD

Stroke is a leading cause of death and a major source of disability worldwide. A Brazilian study performed by Martins and colleagues found that the percentage of hospitals with stroke centers, Emergency Medical Services (EMS), telemedicine, and endovascular services increased significantly between 2008 and 2017, after implementing a task force on stroke by neurologists with the assistance of the Brazilian Ministry of Health. However, these hospitals, equipped with specialized stroke centers, were concentrated in dense urban areas, neglecting the impoverished areas.

Now, the Brazilian Stroke Network aims to expand this model already tested in the urban regions to other parts of the country. Using mobile health technology and telemedicine, it has successfully provided the patients direct access to senior neurologists, who can diagnose complex cases and recommend treatment, hence shortening door-to-needle time and achieving better functional outcomes after stroke. However, it is still too expensive to be implemented nationwide.

World Stroke Day: Get Involved! Share Your Story.

Burton J. TabaacBurton J. Tabaac, MD

Stroke recovery is a global endeavor currently affecting about 80 million people living in the world today. More than 50 million stroke survivors live with some form of permanent disability.

Join the fight against stroke! In 2015, The World Stroke Campaign focused on raising awareness of stroke prevention and risk among women using the tagline, “I am Woman – Stroke Affects Me, Stroke Affects Everyone.” In 2016, World Stroke Day was marked by recognizing that although stroke is a complex medical issue, there are ways to significantly reduce its impact. The World Stroke Organization built a campaign to underscore that “Stroke is Treatable.” Last year, the World Stroke Day 2017 campaign focused on risk awareness and prevention. This year, World Stroke Day 2018, emphasizes that there are resources and a network to assist those who have suffered from stroke. You are not in it alone! There is a well-developed network for caregivers, families, and friends affected by stroke who can help their loved ones #UpAgainAfterStroke.