Stroke management in North Portugal

Acute stroke is an emergency that requires a fast, time-sensitive treatment. If not promptly treated, it may cause severe neurologic impairment, resulting in limited functional status and loss of quality of life.  Therefore, an organized system of care is essential, focusing on prevention primary prevention, prehospital care, acute phase treatment, rehabilitation and community reintegration.  

In Portugal, stroke is the leading cause of death and permanent disability, with an important socioeconomic impact affecting all regions. The Northern Regional Health Administration (ARS Norte) is a political identity responsible for strategic management of population’s health in the north of Portugal, supervising 10 hospital centres and 6 hospitals. These include 7 Primary Stroke Centres offering intravenous thrombolytic treatment and 4 Comprehensive Stroke Centres (CSC) where additionally mechanical thrombectomy can be performed.
A patient with a suspected stroke is transported by an emergency team to the nearest hospital with a structured stroke code. In the hospital the patient is evaluated by a stroke team according to a guideline based care. The patient then performs brain imaging exams and, if indicated, is treated with acute phase therapies, such as intravenous thrombolysis and mechanical thrombectomy (the last one in CSC). This chain sometimes implies hospital transfers that may last minutes to hours, depending on the distance and available means to take the patient from one PSC to a CSC. 

In order to improve the coordination between the several agents involved in the stroke care pathway, ARS Norte created a team with elements from the 11 hospitals. The conception of a local registry became an important initiative to revise current practices and propose new strategies to better treat patients in this region. The participation as an ICTUSnet partner will help to achieve these goals, especially in those patients treated with mechanical thrombectomy.