Cic edizioni internazionali
Functional Neurology

Acute ischemic stroke management in Lebanon: obstacles and solutions

Original Article, 167 - 176
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Abstract
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Management of acute stroke varies greatly within and between different countries. This study assesses the current practices of physicians in Lebanon routinely involved in ischemic stroke (IS) management. We conducted a prospective observational study of patients hospitalized at 8 different Lebanese hospitals in the period August 1, 2015 to July 31, 2016, with a diagnosis of acute stroke. Baseline characteristics and data on diagnostic studies, as well as treatments received during hospitalization and at discharge, were collected and analyzed. Two hundred and three strokes/transient ischemic attacks (TIAs) were recorded but only 173 patients (85%) with ischemic events were included in the study. The patients’ mean age was 69.8±12.7 years. All underwent brain imaging (CT scan and/or MRI) on admission. All ISs were managed by a neurologist, and patient management included consultation of a cardiologist. Hypertension was the most prevalent risk factor (78.6%), followed by a current cigarette smoking habit (50.3%), diabetes mellitus (42.8%), hypercholesterolemia (39.9%), previous stroke or TIA (17.3%), and atrial fibrillation (14.7%). Only four patients (accounting for 2.5% of the ISs) received thrombolytic therapy. More than 89% of the patients were discharged on at least one anti-hypertensive drug, 89.2% on statins and 37.6% on antidiabetic medications. More than 55% of patients were dependent at discharge, as shown by a modified Rankin Scale (mRS) score of 0-2, whereas 33% were independent (mRS score of 3-5). There are many challenges facing stroke care in Lebanon, and there is potential for improvement in this setting. Reperfusion therapy is still largely underused and remains a major challenge in achieving guideline-based reperfusion goals.

Vol. XXXIV (No. 3) 2019 July/September

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