Rapid treatment of minor strokes reduces the risk of a subsequent major stroke by 80 per cent, research published this morning has found. Clinics offering this type of rapid assessment of patients with suspected strokes are now operating in north Dublin.
Prof Peter Rothwell and his colleagues from the Stroke Prevention Unit at the Radcliffe Infirmary, University of Oxford, looked at more than 1,200 patients who presented with either a minor stroke or a transient ischaemic attack (TIA), also known as a mini stroke.
Some patients received urgent assessment and immediate treatment in specialist clinics, others were routinely assessed in hospital but treated in primary care.
The results, published online today by the Lancet, show that when patients were urgently assessed and treated on the same day, the risk of a full-blown stroke in the subsequent 90 days dropped from 10.3 per cent to 2.1 per cent. Using the standard method of care meant that people had to wait on average three days before assessment and some 20 days for treatment to be initiated, with the result that some patients progressed to a full stroke.
Previous research has found that the risk of a major stroke occurring in the first month after a TIA is 10 per cent. A TIA causes symptoms that are similar to a stroke, such as slurred speech and weakness on one side of the body, but these symptoms resolve within 24 hours.
TIAs are caused by a temporary interruption in blood flow to the brain; they are an important warning sign of a major stroke.
Several treatments are effective in preventing stroke following a TIA, including aspirin, blood pressure lowering drugs, statins (to lower cholesterol), anticoagulants and anti-platelet agents. A surgical operation to arteries in the neck, endarectomy, has also been shown to be effective if the blockage in the artery is 50 per cent or greater.
Neurologists and geriatricians at the Mater, Beaumont and Connolly hospitals in Dublin have set up dedicated clinics to look after patients with a suspected TIA. The FASST (Fast Assessment of Suspected Stroke and TIA) clinics ensure that almost all patients are seen within 24 hours of referral. Since 2006, almost 500 people have been seen at the clinics, with investigations such as ultrasound and MRI scans performed on a same-day basis.
Stroke rates among Dublin FASST patients are approximately 2 per cent, in line with the improvements reported in the Lancet.
Prof Peter Kelly, consultant neurologist and director of the stroke service at the Mater, told The Irish Times almost 4,500 patients could be seen every year if the FASST system was available throughout the Republic.
"The Lancet research and the North Dublin FASST service show that it is possible for hospital specialists and GPs to work effectively together to deliver a high-quality service that is immediately responsive to the needs of patients, without referral to accident and emergency," he said.
In a commentary accompanying the Lancet study, Canadian experts said: "Patients with TIAs and minor strokes are not disabled. If the risk of a disabling stroke can be substantially reduced . . . we strongly recommend that patients should receive the same urgent attention as is provided for those with acute coronary syndromes [ pre-heart attack symptoms]."