ESO East Supplement 2023 - 47

Tiu et al.
47
Figure 2. Educational workshop for IVT organized by Angels
Initiative and Romanian Society of Neurology in Galati, in 2018.
this situation. First, mechanical thrombectomy can be performed
only by interventional radiologists, who are also performing
all kinds of procedures like embolization of uterine
fibromas, angioplasty and stenting for peripheral arteries,
guided biopsies, and others. A reduced number of radiologists
choose to be trained in interventional radiology and even
fewer in interventional neuroradiology. The solution is to create
a program of training dedicated to interventional neuroradiology
and to increase the recruitment area by accepting
other specialties for training, at least neurologists and neurosurgeons.
Second, we need to increase the funding for the
existing centers in order to reach a sufficiently large number
of procedures per center to allow the concomitant training of
several specialist, in accordance with ESMINT criteria.3
Third, we need to increase the number of centers able to perform
MT and to establish the exact catchment area for each
center, to avoid the waste of time and resources generated by
the lack of established drip-and-ship protocols. Fourth, we
can increase the number of eligible patients by routinely performing
CT angiography (CTA) in every primary stroke
center and by extending the time window outside 6 h by utilizing
perfusion CT (CTP). The number of centers performing
routinely CTA and CTP are shown in Figure 4(a) and (b)
(results from a questionnaire run by Razvan Radu, Elena
Terecoasa, and Cristina Tiu in October 2020, results communicated
in the 18th Congress of the Romanian Society of
Neurology). CTA is available only in 42.5% of the stroke
centers. Tg. Mures County Hospital is the only center with a
CTP software available, although it is not used routinely.
Despite the reduced number of procedures/centers, the
door to groin time interval has constantly improved. We
notice a paradoxical situation in RES-Q registry, where
DTN time for Romania in the first quarter of 2022 is 60 min
and DTG is 48.5, the reason being that many patients were
transferred from other primary centers to the comprehensive
stroke centers, so that the medical staff involved was
practically pre-notified and things moved much faster. If
we look at the national data obtained from the National
Registry for Interventional Treatment in Acute Ischemic
Stroke and from direct interviews with the stroke centers
coordinators, the results are less optimistic, the median
DTG for the interval January to March 2022 being 80 min.
Figure 3. IVT rate in Romania (number of IVT/total number of
ischemic strokes hospitalized during 2021). In Bucharest, there
are seven hospitals that can perform IVT (SUUB-University
Emergency Hospital Bucharest, University Emergency Hospital
Elias, Emergency Clinical Hospital Floreasca, Military Hospital
" Carol Davila, " INNBN - National Institute of Neurovascular
Disorders, Colentina Hospital, Clinical Institute Fundeni).
There are two IVT centers/county in Neamt (Piatra Neamt and
Roman) and in Vaslui (Vaslui and Barlad). All other counties
have only one center able to perform IVT.
Hospital " Pius Brinzeu " Timisoara) and two other centers
with reduced activity. There are several problems leading to
Admittance into stroke units
There are 14 stroke units in Romania defined according to
OMS No. 1408/2015, published in the Official Monitor Part
I nr 870, November 20th, 2015 (Table 3). Obviously, given
the large number of strokes, only a small percentage of
patients are admitted to a stroke unit. There is an increasing
number of patients admitted to a monitored bed. In Romania
stroke is treated only by neurologists, but certain cases are
admitted in other departments (either initially unrecognized
minor strokes, or the opposite, very severe strokes who need
to be taken care of in Intensive care Units).
ESO East Supplement 2023

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