Our Resident Medical Officer (RMO) will first conduct
a priority assessment on the suspected stroke patient
upon arrival at the 24-hour Outpatient Department (OPD).
If the preliminary diagnosis of acute stroke is established,
ASAP 1.0 will be activated and priority CT brain scan
will be performed on the patient to differentiate between
haemorrhagic and ischaemic stroke. At the same time,
an in-house neurologist will be called back to provide
In general, intravenous thrombolytic therapy is most
effective if it can be commenced within 3 hours of the
onset of stroke. Some patients may show improvement
when treatment is commenced within 4.5 hours.
What is Thrombolytic Therapy?
Thrombolysis is a treatment to break up and dissolve
blood clots in blocked blood vessels. Alteplase (or rtPA)
is a thrombolytic (or ‘clot-dissolving’) medicine that can
be given intravenously to dissolve the blood clot and
possibly restore the blood supply to the brain tissue
affected by acute stroke, thereby improving the chance
of recovery after acute stroke.
Thrombolytic therapy is most effective if given within
3 hours from the onset of acute stroke symptoms.
While on average only 1 in 4 (26%) patients recover to
full independence following an ischaemic stroke, the
same outcome is achieved in another 1 in 8 patients
(13%) after thrombolytic therapy. Certain patients may
also benefit from thrombolytic therapy given up to
4.5 hours from acute stroke onset.
What are the Risks of
Haemorrhage (bleeding) in the brain or other parts
of the body is the most significant risk of thrombolytic
therapy. Approximately 1 in 15 (6%) patients treated
with thrombolytic therapy develops bleeding in the brain
that worsens neurological impairment, or even leads to
death in 1% of patients. The same type of bleeding may
also occur in the damaged brain tissue of ischaemic
stroke patients not treated with thrombolytic therapy.
Close monitoring and control of blood pressure are
required during the first 24 hours after thrombolytic
therapy. The stroke team will determine one's eligibility
for thrombolytic therapy based on the clinical profile
and brain scan findings. The treatment may not be
considered for patients with certain medical conditions
that increase the risk of bleeding in the brain or other
organs, a past history of bleeding in the brain, or stroke
beyond the recommended time window.
What Treatment will I Receive if I Choose
Not to Receive Thrombolytic Therapy?
If you are considered not eligible for or choose not
to receive thrombolytic therapy, you will receive
the standard treatment for acute stroke including
antiplatelet therapy, cholesterol lowering therapy,
blood pressure stabilisation, nursing care and
physiotherapy to prevent complications and enhance
the outcome of rehabilitation. The package charges are
not applicable in this case.
ASAP 2.0 will be activated when severe stroke patients
show no improvement after intravenous thrombolytic
therapy or arrive at the hospital after the desirable time
limit. MRI or CT perfusion scanning will be performed
on the brain and cerebral blood vessels to confirm large
vessel blockage. To determine if one is suitable for IA
thrombectomy, the amount and ratio of the salvageable
and irreversibly damaged brain tissues can now be
assessed and calculated using the RapidAI software.
Timely treatment is vital to ensure survival and
satisfactory recovery of acute stroke patients. The AI
system plays a significant role in saving time as the
report can be generated in about 10 minutes, thereby
enabling neurologists and neurosurgeons to decide on
the best treatment option for individual patients most
effectively, efficiently and beyond the 3-hour time limit,
e.g. the feasibility of IA thrombectomy.
What is IA Thrombectomy?
IA thrombectomy is a minimally invasive surgery for
acute ischaemic stroke patients with large vessel
During the procedure, the neurosurgeon will try to
reestablish blood flow to the affected part of the brain
by using catheters to reach the blocked brain vessels
and remove the blood clot. IA thrombectomy is best
performed within 6 hours of the onset of severe stroke.
Research has shown good functional outcome in
ischaemic stroke patients who meet certain criteria and
receive IA thrombectomy within 16 or 24 hours after
onset based on the perfusion scans and AI analysis.
What are the Risks of IA Thrombectomy?
IA thrombectomy has certain risks, such as blood
vessel damage. The attending doctors must carefully
assess the patients’ eligibility for this procedure based
on the AI-generated data. Under ASAP 2.0, patients
are transferred to the High Dependency Unit (HDU) or
Intensive Care Unit (ICU) after IA thrombectomy, and
are closely monitored for blood pressure and vital signs
in the next 24 to 48 hours.
What are the other Roles of
Neurosurgery in Acute Stroke
Joint management with a neurosurgeon is required in
the following clinical settings:
• Haemorrhagic stroke, including subarachnoid
• Haemorrhagic transformation of ischaemic stroke,
including those occurring after thrombolytic therapy
• Large areas of damaged brain tissue in ischaemic
stroke causing brain swelling and impairment in
Charges for ASAP 1.0 and 2.0
Hong Kong Sanatorium & Hospital offers service
packages to acute ischaemic stroke patients with
eligibility assessment and thrombolytic therapy.