ESO East Supplement 2023 - 17

Topcuoglu and Ozdemir
17
Figure 1. Distribution of stroke centers and units. Distribution of stroke centers (top) and stroke units (bottom) in Turkey.
According to the provincial population-based analysis, stroke units covered 60.3% of Turkey's population (84.7 million as of
13.03.2022), and stroke centers 70.5%. The total population of the provinces without stroke units and centers is around 13 million,
which corresponds to 15.4%.
" Stroke units " are an adaptation of " the primary stroke
centers " for our country. These hospitals are generally
located in small settlements where IV tPA can be administered
and patients who do not need critical and advanced
neurological management methods can be hospitalized.
The in-patient units of these hospitals must contain a
minimum of four dedicated beds. The hospital should be
capable of performing 7/24 of computed tomography
(CT) and CT angiography. Stroke units are expected to
operate in coordination with the stroke center on a
regional basis. Provincial health directorates usually take
a position in the creation of this regional system of acute
stoke care.
Stroke centers include neurology intensive care units,
angiography suits where all kinds of neurointerventional
procedures can be performed, as well as advanced imaging,
operation, care and monitoring utilities/facilities available
on 24/7 basis. Acute ischemic stroke cases with major cerebral
vascular occlusion and requiring neurological intensive
care, and almost all acute intracerebral and subarachnoid
hemorrhages are managed in stroke centers (Table 1).
The stroke directive has also implemented several key
rules that are critical to the functioning of these two types of
centers. The first, all kinds of medical management procedures
of acute stroke patients will be carried out under the
responsibility of the neurologist appointed as the stroke
unit and stroke center director. The second, neuro-interventional
procedures can be performed by neurology, cardiology,
radiology, and neurosurgery specialists who meet
defined competency requirements. Specialist physicians
who will perform neurointerventions must have done at
least 100 intracranial neurointerventions. At least 10 of
these intracranial interventions should include mechanical
thrombectomy or thromboaspiration. Specialists who will
perform neurointerventions must have performed at least
20 extracranial neuroendovascular therapeutic interventions
(such as Carotid stent) in the head and neck region.
The list of neurointerventions is given in Table 2. It is mandatory
to document the protocol number of the cases in
which these
neurointerventional
procedures were performed,
together with the angiography reports and, if
requested, video recordings of the procedure. The validity
of the documents is evaluated by the national scientific
commission. The capacity and technical standards of the
angiography suites in stroke centers are also clearly stated
in the directive (Table 1). The third, stroke centers and units
where interventional procedures are performed are first
registered with local certification and then central certification
by the national acute stroke science board. Finally,
each stroke unit and center takes place in the management

ESO East Supplement 2023

Table of Contents for the Digital Edition of ESO East Supplement 2023