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Göteborg, 2018

Timely treatment in stroke and TIA

Akademisk avhandling

som för avläggande av medicine doktorsexamen vid Sahlgrenska Akademin, Göteborgs Universitet kommer att offentligen försvaras i Hjärtats aula, Vita Stråket

12, Sahlgrenska Universitetssjukhuset, Göteborg fredagen den 16 november kl. 9.00

av

Annika Nordanstig Fakultetsopponent:

Docent Mia von Euler

Karolinska Institutet, Stockholm, Sverige Avhandlingen baseras på följande delarbeten:

I. Nordanstig A, Jood K and Rosengren L. Public stroke awareness and intent to call 112 in Sweden. Acta Neurol Scand. 2014; 130:400-4.

II. Nordanstig A, Asplund K, Norrving B, Wahlgren N, Wester P, Rosengren L.

Impact of the Swedish National Stroke Campaign on stroke awareness. Acta Neurol Scand. 2017;136(4):345-51.

III. Nordanstig A, Palaszewski B, Asplund K, Norrving B, Wahlgren N, Wester P, Jood K, Rosengren L. Evaluation of the Swedish National Stroke Campaign: a population-based time-series study. Manuscript.

IV. Nordanstig A, Rosengren L, Strömberg S, Österberg K, Karlsson L, Bergström G, Fekete Z, Jood K. Editor’s Choice - Very Urgent Carotid Endarterectomy is Associated with an Increased Procedural Risk: The Carotid Alarm Study. Eur J Vasc Endovasc Surg. 2017; 54:278-286.

SAHLGRENSKA AKADEMIN INSTITUTIONEN FÖR

NEUROVETENSKAP OCH

FYSIOLOGI

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Göteborg, 2018

Timely treatment in stroke and TIA

Annika Nordanstig

Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden

Abstract

In acute stroke, the effect of both acute treatments and secondary prevention is time- dependent. Patients´ delay is an important obstacle to acute recanalization therapy for stroke. To decrease this delay, a stroke educational campaign was carried out in Sweden. After an ischemic event, the risk of early recurrent stroke is particularly high if the event is caused by a carotid stenosis. Urgent carotid endarterectomy (CEA) reduce the risk of recurrent stroke, but the optimal timing for CEA after a cerebrovascular event is not known because of uncertainties with respect to the procedural risk in very urgent CEA. The aim of this thesis was to investigate the effects of the stroke campaign, and to investigate the procedural risk of very urgent CEA.

Study I, a study based on telephone interviews, evaluated public stroke knowledge and intent to call 112 before the stroke campaign. Seventy-two percent could report at least one stroke symptom and 65% indicated they would call 112 for stroke.

Study II, a study based on telephone interviews, investigated the effect of the campaign on awareness of the AKUT (equivalent to the FAST, Face-Arm-Speech- Time) test and intent to call 112. Before the campaign started, 15% had heard about the AKUT test, compared with 51% during and directly after the campaign, and 50%

21 months later. Corresponding figures were 65%, 76% and 73% for intent to call 112.

Study III, a prospective national study, evaluated the effect of the campaign on pre- hospital delay and recanalization therapy rate. During the campaign, but not the year before, nor the year after, the proportion arriving at hospital < 3h from stroke onset and the proportion receiving recanalization therapy increased significantly.

Study IV, a prospective controlled study, compared the procedural risk in patients undergoing CEA < 48 h with CEA 2-14 d from an ischemic event. Patients undergoing CEA < 48 h from symptom onset had a higher risk of complications (stroke and/or death) compared with those operated on later, 8.0% versus 2.9%.

In conclusion, public awareness of stroke was rather low in Sweden and was increased by the Swedish National Stroke Campaign. The campaign was also associated with a sustained increase in the proportion receiving recanalization therapy and with a small improvement of the proportion arriving at hospital within three hours.

CEA < 48 h was associated with a higher procedural risk compared with surgery 2-14 d after an ischemic event.

ISBN: 978-91-7833-107-9 (PRINT)

ISBN: 978-91-7833-108-6 (PDF) http://hdl.handle.net/2077/56917

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Göteborg, 2018 Keywords: stroke, transient ischemic attack, campaign, carotid artery stenosis.

ISBN: 978-91-7833-107-9 (PRINT)

ISBN: 978-91-7833-108-6 (PDF) http://hdl.handle.net/2077/56917

References

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