Changes in the management of acute ischemic stroke after publication of Japanese Guidelines for the Management of Stroke (2004) ─A multicenter cooperative study in Toyama Prefecture─

Abstract

Background and Purpose: It is unclear whether the management of stroke has been improved since the Japanese Guidelines for the Management of Stroke (2004) was published. The aim of the present study was to clarify changes in the management for acute ischemic stroke after publication of the Japanese Guidelines. Methods: We investigated the management of patients with acute ischemic stroke in nine hospitals belonging to the committee of Toyama Acute Ischemic Stroke Study, before and after publication of the Japanese Guidelines for the Management of Stroke (2004). Results: Two-hundred and ninety-three acute ischemic stroke patients were registered in 2003 and 237 in 2006, respectively. The percentage of lacunar stroke was 39％, 37％, atherothrombotic infarction; 28％, 30％, cardioembolic stroke (CE); 21％, 22％, and others; 12％, 11％, respectively. The ratio of CE patients who were admitted within 3 hours of onset was significantly increased from 34％ in 2003 to 57％ in 2006. Although 74 patients (31％) with any clinical type were admitted within 3 hours of onset, thrombolytic therapy with tissue plasminogen activator (rt-PA) was administered to only 5 patients (2.1％) in 2006. Diffusion weighted images became available in all hospitals, and were more frequently used for diagnosis of acute ischemic stroke in 92％ of patients in 2006 as compared to 59％ in 2003. Ischemic lesions were more frequently detected before the start of treatment in 52％ of patients in 2006 as compared to 43％ in 2003. Conclusions: After the Japanese Guidelines for the Management of Stroke (2004) was published, the treatment of acute ischemic stroke patients appeared to follow this guideline in many patients. Thrombolytic therapy with rt-PA, however, was performed in very few patients.