How to improve access to appropriate therapy and outcome of the acute ischemic stroke: a 24-month survey of a specific pre-hospital planning in Northern Italy

Few patients with acute cerebral infarction are medicated with thrombolysis as yet. Thus, a specific plan was created in the area of Bergamo in Northern Italy to increase the number of procedures. The plan, started in 2010, consisted of: (1) subdivision of the area of Bergamo into three zones, each one served by a single Stroke-Unit (SU) licensed to thrombolysis; (2) information to population via newspapers and local broadcasting; and (3) teachings both to personnel of Emergency Medical Service and General Practitioners. Here, we have compared the results of the SU of Policlinico San Marco in the years 2008–2009 versus those in the years 2010–2011. During 2008 and 2009, SU admitted 376 acute ischemic strokes, 60 of whom (16 %) within 3 h of the event. Of those patients, 8 (2 %) were treated with thrombolysis. At 3 months of stroke, 61 patients (16 %) were alive and self-independent. During 2010 and 2011, SU admitted 401 acute ischemic strokes, 91 of whom (22 %) within 3 h of stroke. Of those patients, 23 (6 %) were treated with thrombolysis. At 3 months of stroke, 100 patients were alive and self-independent (25 %). The increases of thrombolytic procedures (p = 0.0171), of self-independent patients (p = 0.0036), and of patients arriving within 3 h of stroke (p = 0.0226) were statistically significant. In conclusion, our study shows that a specific plan increases the numbers of thrombolysis and of self-independent patients at 3 months of stroke.