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Reperfusion therapy for ischemic stroke in the Russian Federation: Problems and promises

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Current technologies for treating ischemic stroke (IS) within the first 4.5 hours after its onset involve highly effective brain substance reperfusion techniques (thrombolytic therapy (TLT)) aimed at restoring blood flow in the affected vessel. There has been a substantial increase in the number of systemic TLT procedures after establishing stroke subdivisions as part of regional vascular centers and primary vascular departments in our country. In the past 5 years, the number of IS patients undergoing systemic thrombolysis has virtually risen 10-fold. In 2009–2013, the primary and regional centers of the Russian Federation performed 10,718 systemic TLT procedures mainly in patients with moderate stroke. The further increase in the number of reperfusion procedures in IS patients is hindered by the fact that they seek medical advice too late for acute cerebrovascular attack (ACVA) because the population has low medical knowledge (therefore education campaigns are so important for the population to increase its awareness of the signs of ACVA), prehospital delays and problems, poor organization of hospital admission (delays in diagnostic procedures).

It is important that the patients should be admitted to specialized ACVA departments as soon as possible. According to the AHA/ASA guidelines, the time between admission and TLT initiation (door-to-needle time) should not exceed 60 minutes. The major factors influencing the door-to-needle time are as follows: the time between admission and neurological examination, that between neuroimaging and its results, that of examination of necessary laboratory findings, that between admission and transfer to an intensive care unit after computed tomography. One may identify the following quality indices of the procedures (necessary diagnostic, therapeutic, and other interventions), which negatively affect the safety and efficiency of TLT: errors in determining contraindications to reperfusion, noncompliance with the protocol of thrombolysis, and further patient monitoring.

In terms of the available potential of the established stroke departments, it is absolutely real to increase the number of TLT procedures through active information campaigns among the population, which will contribute to the earliest admission of patients with ACVA to the specialized departments, and it is also necessary to make further organizational improvements of the healthcare system for stroke patients at its all stages.

About the Author

N.A. Shamalov
Research Institute of Cerebrovascular Pathology and Stroke, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, Moscow, 1, Ostrovityanov St., Moscow 117997
Russian Federation


1. Krishnamurthi RV, Feigin VL, Forouzanfar MH. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health. 2013;1(5):e259–e81. DOI: 10.1016/S2214-109X(13)70089-5. Epub 2013 Oct 24.

2. Available from:

3. Jauch EC, Saver JL, Adams HP Jr, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(3):870–947. DOI: 10.1161/STR.0b013e318284056a. Epub 2013 Jan 31.

4. Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med. 1995;333(24):1581–7. DOI:

5. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA.

6. ;274(13):1017–25. DOI:

7. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet. 1998;352(9136):1245–51. DOI:

8. Clark WM, Wissman S, Albers GW, et al. Recombinant Tissue-Type Plasminogen activator (Alteplase) for ischemic stroke 3 to 5 hours after symptom onset. The ATLANTIS Study: A Randomized Controlled Trial. Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke. JAMA. 1999;282(21):2019–26. DOI:

9. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with Alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359(13):1317–29. DOI: 10.1056/NEJMoa0804656.

10. Fagan SC, Morgenstern LB, Petitta A, et al. Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. NINDS rt-PA Stroke Study Group. Neurology. 1998;50(4):883–90. DOI:

11. Guzauskas GF, Boudreau DM, Villa KF, et al. The cost-effectiveness of primary stroke centers for acute stroke care. Stroke. 2012;43(6):1617–23. DOI:10.1161/STROKEAHA.111.648238. Epub 2012 Apr 25.

12. Kruyt ND, Nederkoorn PJ, Dennis M, Leys D et al. Door-to-needle time and the proportion of patients receiving intravenous thrombolysis in acute ischemic stroke. Stroke. 2013;44(11):3249–53. DOI: 10.1161/STROKEAHA.113.001885. Epub 2013 Sep 19.

13. Скворцова ВИ, Голухов ГН, Губский ЛВ и др. Системная тромболитическая терапия при ишемическом инсульте. Журнал неврологии и психиатрии им. С.С. Корсакова. 2006;106(12):24–31. [Skvortsova VI, Golukhov GN, Gubskii LV, et al. System thrombolytic therapy at an ischemic stroke.

14. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2006;106(12):24–31. (In Russ.)]

15. Скворцова ВИ, Голухов ГН, Волынский ЮД и др. Высокая эффективность селективного внутриартериального тромболизиса при лечении ишемического инсульта у больных с окклюзией артерий крупного калибра. Журнал неврологии и психиатрии им. С.С. Корсакова. 2006;106(12):32–40. [Skvortsova VI, Golukhov GN, Volynskii YuD, et al. High efficiency of a selective intra arterial

16. trombolizis at treatment of an ischemic stroke at patients with occlusion of arteries of large caliber. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. 2006;106(12):32–40. (In Russ.)]

17. Демин ТВ, Сайхунов МВ, Хасанова ДР. Опыт применения внутривенного тромбо-

18. лизиса при ишемическом инсульте». Неврология, нейропсихиатрия, психосоматика. 2010;(1):42–7. [Demin TV, Saikhunov MV, Khasanova DR. Experience in using intravenous thrombolysis in ischemic stroke. Nevrologiya, neiropsikhiatriya, psikhosomatika=Neurology, Neuropsychiatry, Psychosomatics. 2010;(1):42–7. (In Russ.)]. DOI:

19. Домашенко МА, Максимова МЮ, Лоскутников МА и др. Механизмы реперфузии при внутривенной тромболитической терапии у пациентов с ишемическим инсультом. Неврология, нейропсихиатрия, психосоматика. 2012;(4):53–8. [Domashenko MA, Maksimova MYu, Loskutnikov MA, et al. The mechanisms of reperfusion during in stroke patients treated with intravenous thrombolysis.

20. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2012;(4):53–8. (In Russ.)]. DOI:

21. Скворцова ВИ, Шамалов НА, Анисимов КВ, Рамазанов ГР. Результаты внедрения тромболитической терапии при ишемическом инсульте в Российской Федерации. Журнал неврологии и психиатрии им. С.С. Корсакова. Приложение Инсульт. 2010;12(2):17–22. [Skvortsova VI, Shamalov NA, Anisimov KV, Ramazanov GR. Results of introduction of thrombolytic therapy at an

22. ischemic stroke in the Russian Federation. Zhurnal nevrologii i psikhiatrii im. S.S. Korsakova. Issue Stroke. 2010;12(2):17–22. (In Russ.)]

23. Bray BD, Campbell J, Cloud GC, et al. Bigger, Faster? Associations between hospital thrombolysis volume and speed of thrombolysis administration in acute ischemic stroke. Stroke. 2013;44(11):3129–35. DOI: 10.1161/STROKEAHA.113.001981. Epub 2013 Sep 19.

24. Kunisawa S, Kobayashi D, Lee J, et al. Factors associated with the administration of tissue plasminogen activator for acute ischemic stroke. J Stroke Cerebrovasc Dis. 2014 Apr;23(4):724–31. DOI: 10.1016/j.jstrokecerebrovasdis. 2013.06.033. Epub 2013 Jul 30.

25. Katzan IL, Hammer MD, Hixson ED. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol. 2004;61(3):346–50. DOI:

26. Van Wijngaarden JD, Dirks M, Niessen LW, et al. Do centres with well-developed protocols, training and infrastructure have higher rates of thrombolysis for acute ischaemic stroke? QJM. 2011;104(9):785–91. DOI:10.1093/qjmed/hcr075. Epub 2011 May 24.

27. Van Wijngaarden JD, Dirks M, Huijsman R, et al. Hospital rates of thrombolysis for acute ischemic stroke: the influence of organizational culture. Stroke. 2009 Oct;40(10):3390–2. DOI:

28. Boode B, Welzen V, Franke C, van Oostenbrugge R. Estimating the number of stroke patients eligible for thrombolytic treatment if delay could be avoided. Cerebrovasc Dis. 2007;23(4):294–8. DOI:


30. Keskin O, Kalemoglu M, Ulusoy RE. A clinic investigation into prehospital and emergency department delays in acute stroke care. Med Princ Pract. 2005;14(6):408–12. DOI:

31. Mosley I, Nicol M, Donnan G, et al. The impact of ambulance practice on acute stroke care. Stroke. 2007;38(10):2765–70. DOI:

32. Stern EB, Berman M, Thomas JJ, Klassen AC. Community education for stroke awareness: an efficacy study. Stroke. 1999;30(4):720–3. DOI:

33. Hodgson C, Lindsay P, Rubini F. Can mass media influence emergency department visits for stroke? Stroke. 2007;38(7):2115–22. DOI:

34. Гусев ЕИ, Скворцова ВИ, Стаховская ЛВ и др. Эпидемиология инсульта в России. Журнал неврологии и психиатрии им. С.С. Корсакова. Приложение Инсульт. 2003;(8)4–9. [Gusev EI, Skvortsova VI, Stakhovskaya LV, et al. Stroke epidemiology in Russia. Zhurnal nevrologii i psikhiatrii im. S.S.

35. Korsakova. Issue Stroke. 2003;(8)4–9. (In Russ.)]

36. Биденко МА, Шпрах ВВ. Оценка качества оказания медицинской помощи больным мозговым инсультом по данным госпитального регистра в г. Иркутске. Сибирский медицинский журнал. 2009;85(2):68–70. [Bidenko MA, Shprakh VV. Estimation of medical assistance to yhe patients with cerebral insult on the data of hospital register in Irkutskcity. Sibirskii meditsinskii zhurnal.2009;85(2):68–70. (In Russ.)]

37. Скворцова ВИ, Стаховская ЛВ, Лелюк ВГ и др. Становление системы оказания медицинской помощи больным с церебральным инсультом в Российской Федерации. В кн.: Материалы Всероссийской научно-практической конференции «Совершенствование оказания медицинской помощи больным с сосудистыми заболеваниями». Ярославль, 2011. Москва: Реал-Тайм; 2011. С. 13–33. [Skvortsova VI, Stakhovskaya LV, Lelyuk VG, et al. Formation of system of delivery of health care by the patient with a cerebral stroke in the Russian Federation. In:Materialy Vserossiiskoi nauchno-prakticheskoi konferentsii «Sovershenstvovanie okazaniya meditsinskoi pomoshchi bol'nym s sosudistymi

38. zabolevaniyami». Yaroslavl', 2011 [Materials of the All-Russian scientific and practical conference

39. «Improvement of Delivery of Health Care by the Patient with Vascular Diseases». Yaroslavl, 2011]. Moskva: Real-Taim; 2011. S. 13–33.

For citation:

Shamalov N. Reperfusion therapy for ischemic stroke in the Russian Federation: Problems and promises. Neurology, Neuropsychiatry, Psychosomatics. 2014;6(2S):15-22. (In Russ.)

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