AIT clinic opens to cure warning signs of probable stroke

Preventing strokes (cerebrovascular accidents) by offering diagnostics and preventive treatments to people who have just suffered a TIA (transient ischemic attack), this is the mission of the AIT clinic which has just opened this Monday at Bordeaux University Hospital. Its manager, Pauline Renou, is a neurologist in the neurology department and the neurovascular unit of Dr. Igor Sibon.

Can you start by explaining the difference between a stroke and a TIA?

A stroke occurs when an artery in the brain becomes blocked and the patient has paralysis, difficulty speaking. In stroke these symptoms will persist for several days, weeks or years and the artery remains clogged. The AIT is like a “mini stroke”, the artery unclogs in a few minutes and therefore the patient presents symptoms (the same as for a stroke), but transient and he recovers very quickly.

Currently, how are these AIT supported?

After drawing up an inventory with the 1,100 general practitioners in the Bordeaux area, we know that everyone is dealing with one to two AIT per month, or around 30 AIT per day in Bordeaux Métropole. In 60% of cases, they are managed by the general practitioner in conjunction with a cardiologist, in 20% they come to the emergency room of Pellegrin, and the remaining 20% ​​are distributed in other structures such as clinics.

Patients are not necessarily aware that their symptoms are of an emergency nature?

They are falsely reassured that it doesn’t last long, so either they do nothing or they call their doctor, sooner or later. If he recommends emergencies, there is sometimes a reluctance to go there, because of the delays in the waiting room. In the neurology department, we cannot, unfortunately, take them in an emergency and directly, because we must first manage strokes for which we already have a limited number of beds (16 in intensive care).

The general practitioner often finds himself managing the situation externally with his patient. He will ask for a cerebral MRI (two months delay), a cardiological assessment (three months of waiting), whereas the AIT is an emergency, a warning sign of a probable AVC, which will occur in the hours, the days or weeks to come.

How are these patients cared for?

A patient who has a TIA does not need to stay hospitalized, he needs to be seen by a neurologist and to do additional examinations. This can be done over a fairly short period of time: it is estimated that they will stay between three and four hours at the most at the clinic. We have privileged access to the ER MRI. One of our first patients passed one today, thirty minutes after her arrival in our structure. They then go home with treatment, which essentially thins the blood to prevent a stroke from occurring.

We know that one in four people who have had a stroke have had a TIA before. So there is one that we could have avoided out of the four. And, if we take care of a TIA (emergency examinations and taking preventive treatment), we will avoid the occurrence of a subsequent stroke in 80% of cases, which is enormous.

Who is referring this patient to you?

Patients cannot call themselves. It is the doctors who call us or 15, or SOS doctors. We carried out a whole information campaign with doctors in mainland France (general practitioners, Samu regulators, cardiologists) and we sent them our direct line. As soon as we opened, we already had several calls.

We can accommodate five to six patients at the same time, and, over the day, we can easily estimate the care of about fifteen people. An experienced nurse from the neurology department answers calls from doctors and greets patients. It is a project to which the nurses of the service have joined and which has filled them with enthusiasm. Doctor Pierre Briau, medical assistant, is also attached to the clinic. The goal is to have a small structure, but which allows to take stock of these AIT in emergency.

How does the patient get to the clinic after being referred by their doctor?

The patient will have to come to the clinic, ideally by his own means if he can be accompanied by a loved one. He can’t drive, that’s for sure. If there is no companion, an ambulance is sent.

The opening hours correspond to those of a day hospital: Monday to Friday from 9 am to 6.30 pm. These are pathologies that are treated during the day and, obviously, the means are also more difficult to put in place at night and on weekends.

The needs seem high and exceed the perimeter of the agglomeration, will the structure be able to grow?

Today, we are limited to Bordeaux Métropole, but, in a second step, if the structure works well and we can expand it by putting more human resources, we could expand the recruitment territory. We will be evaluated every six months by the CHU, which has supported this initiative from the start. This clinic will help unclog the emergency room by playing a regulatory role: AIT will be better taken care of and it will sometimes be possible to avoid the passage of certain patients who have somewhat absurd symptoms.

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