2019 Volume 4 Issue 1 Pages 37-43
Objective: Endovascular treatment with or without tissue-plasminogen activator (t-PA) infusion has been becoming the standard first-line therapy for acute ischemic stroke (AIS). It is very difficult to treat patients with AIS in underpopulated regions, because medical resources are limited in such areas. We have discussed about this problem in the special symposium titled “Emergent Neuroendovascular therapy for AIS” at the annual Chugoku-Shikoku regional meeting of the Japanese society for NeuroEndovascular Therapy. We introduce our efforts to overcome these local problems in underpopulated regions.
Methods and Results: 1) A specialist of neuroendovascular therapy was invited to a core hospital in the mountain area. This hospital was covering wide medical regions with predominantly elderly people. The system in the hospital was then constructed for the treatment of AIS like a comprehensive stroke center (CSC). The patients with AIS were concentrated to the core hospital, which resulted in a rapid increase of endovascular treatment and improvement of patients’ outcome.
2) A core hospital started “Mobile Endovascular-therapy” in cooperation with a university hospital which had enough specialists. These efforts made not only a steep increase of endovascular treatment, but also upskilling of the regional physicians. Finally, the regional physicians became able to perform endovascular treatment without aid of the university hospital in a few years.
3) A university hospital was established as a CSC using telemedicine and helicopter transportation for covering the whole area of the prefecture. This method is called “hub-and-spoke” style for AIS treatment, and effectively brought the AIS patients to the university hospital. This energy resulted in improvement of patients’ outcome even in underpopulated regions where the specialists are absent. This “hub-and-spoke” style is becoming a good role model in Japanese remote medical care.
Conclusion: We hope these examples would be helpful references for other Japanese hospitals. In addition, it is very important to continue these kinds of efforts by not only medical staff, but also by organizations concerned with social support.
