The number of patients who are adopted for acute thrombolytic therapy and/or thrombectomy treatment has not increased for many years. To reveal the clinical reason of this will be important for setting up an effective campaign of stroke awareness. Acute stroke patients admitted in hospital within 24 hrs were consecutively screened. The clinical backgrounds were compared between patients for every 6hrs and 6 to 24hrs and also between patients who have taken thrombolysis and/or thrombectomy  and conventional therapy.One hundred fifty-four patients and 177 patients were admitted in hospital within 6hrs and 6 to 24 hrs, respectively. There was no difference of the percentage of previous stroke and anti-thrombotic medication between patients admitted within 6 hrs and 6 to 24 hrs. Among patients within 6hrs, the average age was younger and the percentage of diabetes and previous stroke was lower in the interventional therapy group compared with the conventional therapy group . It can be advised that educating patients by the family doctor might be important for stroke awareness. Moreover, relatively younger healthy people will be the main target for the campaign of stroke awareness.

More than 10 years past, since the acute thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) was officially adopted for the acute therapy for ischemic stroke patients in Japan. At the beginning, rt-PA was allowed to administrate within 3 hours after the stroke onset, and the number of rt-PA treated patients were in less than 5% of all acute stroke patients. Although the time limit was recently extended to 4.5hrs, the number of patients who were treated with rt-PA was not dramatically increased. Recently, it was reported that the rate of thrombolysis in older adults has increased in the United States, from 1.7% to 5.4%. In mean time, these days, the methods of mechanical thrombectomy have been improving, and this therapy combined with medical management could be safely performed within 8hrs following the stroke onset. Since various therapies have presented as the gospel for acute ischemic stroke patients, it is desirable to increase the number of patients who admitted in hospital at the very early phase of stroke. However, because the initial symptoms of the stroke are various, it would be difficult to decide to go to hospital immediately. Actually, many campaign for stroke awareness, including Act FAST campaign, have been conducted across the globe, but it’s effect was limited and short. Thus far, this study can be a good material for thinking about effective campaign to create awareness on stroke, the clinical distinctive features of acute stroke patients who admitted in the hospital later than 6hrs of stroke onset were investigated by comparing with those of patients who admitted in the hospital within 6hrs and treated with thrombolytic therapy and/or thrombectomy.

Following the approval of the ethical committee of Research Institute for Brain and Blood Vessels -Akita, consecutive acute stroke patients admitted in the hospital within 24 hrs following the stroke onset were retrospectively screened between April 2014 and March 2015. All patients consented with written document. Then, 331 acute ischemic stroke patients were enrolled in this study. Diagnosing ischemic stroke was based on the brain magnetic resonance imaging (MRI) or computed tomography (CT) on admission. According to the criteria of the Trial of Org 10172 in the Acute Stroke Treatment classification system., stroke subtypes were classified into cardioembolism (CE), large artery atherothrombosis (AT), small vessel occlusion (SV), and other type of infarction (Others). The clinical backgrounds and vascular risks were collected from clinical record. The assessed risk factors were hypertension, dyslipidemia, diabetes mellitus and atrial fibrillation. Previous stroke history and anti-thrombotic medication were also assessed. Patients admitted to the hospital within 6hrs from the stroke onset was classified into the ≤ 6 hrs group. Patients admitted in the hospital between 6 and 24hrs following the stroke onset was classified into the >6 hrs group. Neurologic severity was assessed by the National Institute of Health Stroke Scale (NIHSS) score on admission. The medication was basically adopted by an attending doctor followed by the guidelines. In the ≤ 6 hrs group, if a patient admitted in the hospital within 4.5hrs following the stroke onset and matched to the acute interventional therapy, the thrombolytic therapy using rt-PA (arteplase 0.6 mg/kg) was administrated following the protocol. Moreover, a patient sequentially undertook the mechanical thrombectomy if matched to the criteria, referred to the Japanese Society for Neuroendovascular Therapy. Alternatively, if a patient admitted in the hospital between 4.5 and 6 hrs following the stroke onset, the mechanical thrombectomy was directly considered. The clinical backgrounds were compared between the ≤ 6 hrs group and the >6 hrs group. The clinical features were also compared between patients of the ≤ 6 hrs group with the conventional therapy and those with the interventional therapy.

With Regards,
Sara Giselle
Associate Managing Editor
Journal of Stroke Research & Therapy