Deans' stroke musings: Improvements in Time-Sensitive Stroke Care and Alteplase Administration: The Iranian Comprehensive Code Stroke Management Program (ICSM Phase III)

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, March 19, 2026

Improvements in Time-Sensitive Stroke Care and Alteplase Administration: The Iranian Comprehensive Code Stroke Management Program (ICSM Phase III)

WOW! Creating a stroke protocol that not even first world countries are doing!

Improvements in Time-Sensitive Stroke Care and Alteplase Administration: The Iranian Comprehensive Code Stroke Management Program (ICSM Phase III)

Shayan Alijanpour, PhD https://orcid.org/0000-0001-7970-8009,

Fatemeh Bahramnezhad, PhD,

Ashkan Mowla, MD,

Shahin Shifteh, MSc,

Zoya Hadinezhad, PhD,

Soraya Khafri, PhD https://orcid.org/0000-0002-2398-7560, and

Nahid Dehghan Nayeri, PhD https://orcid.org/0000-0003-1594-6790 nahid.nayeri@gmail.comAuthor Info & Affiliations

Stroke

New online

https://doi.org/10.1161/STROKEAHA.125.053785

Abstract

BACKGROUND:

Timely management of acute stroke in the emergency medical services setting is critical. Systemic challenges in this phase include the absence of evidence-based standards, inconsistent protocols, and coordination delays. This study aimed to implement and evaluate an updated national stroke protocol in northern Iran.

METHODS:

This quasi-experimental study evaluated the Iranian Comprehensive Code Stroke Management Program. The intervention group (Babol emergency medical services, n=248) received a multi-faceted empowerment program, while the control group (Mazandaran emergency medical services, n=900) received standard training. Patients' level outcomes were assessed on prehospital time, monthly intravenous alteplase counts, and administration rates before (March–September 2023) and after the intervention (March–September 2024).

RESULTS:

Of 1131 suspected stroke codes, 400 (35%) were hospital-confirmed. The intervention significantly reduced most prehospital time intervals (except transport time) and increased the rate of intravenous alteplase administration per hospital-confirmed stroke code from 13.94% preintervention to 39.49% postintervention (absolute increase +25.55%±19.17; P<0.001). Additionally, the mean monthly number of alteplase administrations showed an increasing trend (+4.00±4.64; P=0.07). Conversely, the control group exhibited a significant decrease in the mean number of monthly alteplase administrations (−0.72±0.57; P=0.04) and a nonsignificant reduction in the administration rate (−1.49 percentage points; SD ±6.47; P=0.69).

CONCLUSIONS:

Implementing the updated protocol was associated with significant reductions in critical time intervals and a near-tripling of the intravenous alteplase administration rate in the intervention group. National evaluation should include long-term functional outcomes to confirm effectiveness and establish its value as a model.