Reducing the burden of stroke is a complex issue, and there is some contention as to the best approach in identifying and treating patients at risk. Markku Kaste, MD, PhD, University of Helsinki, Finland, discussed possible strategies of stroke prevention and treatment.

Prof. Kaste favors the population approach in order to identify patients with low or medium risk (in addition to those at high risk) for stroke who benefit from primary preventative measures. This approach has been shown to have a major impact on the burden of stroke. No risk stratification method or treatment is 100% effective. “Doctors are trained to diagnose and treat patients with high risk of stroke. Even in optimal care of them, we are only able to reduce 15% of total stroke, which stresses the importance of primary prevention,” said Prof. Kaste.

“Chain of recovery is important. However, the chain of recovery is only as strong as its weakest link,” said Prof. Kaste. Acute stroke patients should be transported quickly to a well-organized stroke unit whenever possible, as treatment in specialized stroke units is associated with better short-term and long-term outcomes compared with routine medical departments [Kaste M et al. Stroke 1995; Inderdavik B et al. Stroke 1999]. Based on data from a study in Europe, only 14% of stroke patients in Europe are admitted to stroke units, and <10% of European hospitals that admit acute stroke patients have optimal facilities (Table 1) [Leys D et al. Stroke 2007].

As we have already learned, time to thrombolysis is imperative [The ATLANTIS, ECASS, and NINDS r-tPA Study Group Investigators. Lancet 2004; SITS Investigators. Stroke 2008; SITS Investigators. Stroke 2009]. In past years, Prof. Kaste has seen a growth in thrombolysis rates within his hospital, and this trend continues. Last year, 276 stroke patients received thrombolysis in the neurological emergency room of his hospital. Twenty-eight percent of these patients were treated within 90 minutes of symptom onset. This is an indication of where stroke treatment is headed. Telemedicine is also provided for smaller hospitals, because it is more effective to transfer thrombolysis “know-how” than stroke patients, noted Prof. Kaste.

For optimal care to be provided, education, training, and up-to-date guidelines (both national and international) are necessary. Education must also include population-based education. Incorporating symptom recognition, how to act in a case of acute stroke, and risk information in the media setting to educate laypeople will have a huge impact on the burden of stroke.

Evidence-based information regarding the prevention and treatment of acute stroke is readily available, so it is time to transfer that knowledge into clinical practice, concluded Prof. Kaste. Wherever data are missing, it is our responsibility as clinicians to seek out new information and fill in the gaps. More readily available stroke units and faster response times will also contribute to better stroke outcomes in the future.