ESO East Supplement 2023 - 18

18
European Stroke Journal 8(1S)
Table 1. Stroke units/centers minimum requirements.
Stroke units
Specialist
Neurologist (out of working hours, full-time at the
health facility, easily accessible on 7/24 basis)
Bed number
Medical unit and
equipment
Radiologist (able to report on 7/24 basis)
At least four
Computed tomography (with 7/24 service,
angiography capacity)
Emergency biochemistry laboratory (24/7 service)
At least second level adult intensive care service (in
the health facility)
At least second level emergency service
Monitor (one per bed)
Emergency sets (one per unit at minimum)
*Full-time at the health facility, easily accessible on 7/24 basis (out of working hours).
**In the health facility, serving on 24/7 basis.
Stroke centers
Neurologist (Director, in the unit during office hours) At least one specialist* who can perform
neurovascular procedures
Neurosurgeon*
Anesthesiology and reanimation specialist*
Cardiologist*
At least six (Some of them can be arranged within the
adult intensive care unit)
Magnetic resonance imaging**
Cerebral angiography with DSA and road-map**
MR angiography**
Color Doppler ultrasonography**
Cardiovascular surgery clinic where all kinds of
cardiovascular surgery can be performed
Neuro-intensive care service
Neurosurgery clinic, able to perform all kinds of brain
surgery
Third level emergency room (preferably)
Third level adult intensive care service
Table 2. List of neurointerventional processes*.
Intracranial neurointerventions
Extracranial neurointerventions
1. Thromboaspiration or mechanical thrombectomy with modern
devices in acute ischemic stroke
2. Cerebral aneurysm treatment
3. Cerebral arteriovenous malformation treatment
4. Dural arteriovenous fistula treatment
5. Stenting or angioplasty for intracranial atherosclerotic disease
6. Stenting for intracranial dissection
7. Intracranial parental artery occlusion
8. Intracerebral tumor embolization
1. Carotid stent and angioplasty
2. Head and neck tumor embolism
3. Vertebral artery proximal stent and angioplasty
4. Subclavian stenting and angioplasty
5. Extracranial carotid balloon angioplasty test
*As the primary operator, a minimum of 100 intracranial interventions, a minimum of 10 stroke thrombectomy/thromboaspiration, and 20 cervical
artery angioplasty/stenting should be performed (and documented).
network or in a system linked to it, which is planned to
operate at the country level.4
In the process leading up to the stroke directive, " the
national Stroke clinical protocol " 5 and " Stroke diagnosis
and treatment guideline " 6 were published by the Turkish
Ministry of Health with high degree academic cooperation
of Turkish Society of Cerebrovascular Diseases and Turkish
Neurology Society. In addition, these two societies supported
the directive by publishing guidelines and algorithms
such as " Use of IV tPA in acute stroke, " 7,8 " Nursing care and
hospital processes in stroke, " 9 " Non-vitamin-K oral anticoagulant
(NOAC) use, " 10 " Cerebral edema and treatment in
acute stroke, " 11 " Guidelines for the treatment of acute stroke
in the COVID pandemic. " 12
IV tPA and neurointerventional
treatment in Turkey: A short story
and current situation
Intravenous tissue plasminogen activator (IV tPA) was
approved by the Ministry of Health of the Republic of Turkey
in March 2006, approximately 10 years after Europe.13 The
drug is covered in full reimbursement. Estimated utilization
rate in acute stroke patients is about 3%. A national database
does not exist. The use of tPA in stroke meets contemporary
quality criteria, as demonstrated in the Turkish National
Intravenous Thrombolysis Registry14 and a meta-analysis
compiling published local case series.15 In the latter, an analysis
of 2349 cases in 21 publications documented that the

ESO East Supplement 2023

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