Year: 2018
Type: dissertation
Abstract: In acute stroke, the effect of both acute treatments and secondary prevention is timedependent.\nPatients´ delay is an important obstacle to acute recanalization therapy\nfor stroke. To decrease this delay, a stroke educational campaign was carried out in\nSweden. After an ischemic event, the risk of early recurrent stroke is particularly\nhigh if the event is caused by a carotid stenosis. Urgent carotid endarterectomy\n(CEA) reduce the risk of recurrent stroke, but the optimal timing for CEA after a\ncerebrovascular event is not known because of uncertainties with respect to the\nprocedural risk in very urgent CEA. The aim of this thesis was to investigate the\neffects of the stroke campaign, and to investigate the procedural risk of very urgent\nCEA.\nStudy 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\ncampaign on awareness of the AKUT (equivalent to the FAST, Face-Arm-Speech-\nTime) test and intent to call 112. Before the campaign started, 15% had heard about\nthe AKUT test, compared with 51% during and directly after the campaign, and\n50% 21 months later. Corresponding figures were 65%, 76% and 73% for intent to\ncall 112.\nStudy III, a prospective national study, evaluated the effect of the campaign on prehospital delay and recanalization therapy rate. During the campaign, but not the year\nbefore, nor the year after, the proportion arriving at hospital within three hours from\nstroke onset and the proportion receiving recanalization therapy increased\nsignificantly. Study IV, a prospective controlled study, compared the procedural risk in patients\nundergoing CEA < 48 hours with CEA 2-14 days from an ischemic event. Patients\nundergoing CEA < 48 hours from symptom onset had a higher risk of complications\n(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\nincreased by the Swedish National Stroke Campaign. The campaign was also\nassociated with a sustained increase in the proportion receiving recanalization\ntherapy and with a small improvement of the proportion arriving at hospital within\nthree hours. CEA < 48 hours was associated with a higher procedural risk compared\nwith surgery 2-14 days after an ischemic event.
Author: Annika Nordanstig
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2901289145