ESO East Supplement 2023 - 30

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European Stroke Journal 8(1S)
care. In February of 2019, the National Stroke Program
(NSP) was launched by the Government of Armenia.
Initially, two hospitals, the Erebouni Medical Center (EMC)
and the Yerevan State Medical University (YSMU)
Hospital, both with experienced staff and technological
capability, including Computed
Stroke education
Tomography/CT
Angiography, CT Perfusion, Magnetic Resonance Imaging/
Angiography, conventional digital subtraction angiography
for diagnostic and neurovascular intervention applications,
were chosen as comprehensive stroke centers by the
Ministry of Health (MOH). Currently, there are four stroke
centers in Armenia, two of which are privately owned. The
state currently funds acute stroke care whether the patient is
seen at a private or a government-owned facility.
International collaboration
Dynamic and long-lasting academic collaborations were
established in 2014 among an international faculty of stroke
experts, EMC and YSMU. Stroke conferences in Armenia
and abroad, regular lecture series, stroke case discussions,
bedside teaching during hospital and clinical visits, international
observership opportunities, joint sessions to develop
stroke care pathways, and protocols suitable to local realities
proved valuable tools for transferring knowledge. As a
result of international collaboration, a stroke unit was
opened at the EMC in May of 2014. The development of
stroke care was further invigorated when Armenia joined
the European Stroke Organization (ESO) in 2016. The
Registry of Stroke Care Quality (RES-Q) program was activated
that year. Several neurologists participated in the
Angels program, which offers training for acute stroke care
through case simulations.13 This program is of great value
and provides a unique experience to neurologists who are in
the process of forming a stroke team. In 2017 the Stroke
Advisory Task Force for Armenia (SIATA) was founded by
stroke experts from Canada, France, Russia, and the US, to
advance stroke education and care in Armenia by facilitating
the transfer of scientific evidence and with a spirit of
public service. Since its founding, SIATA has continued to
serve its mission by advising and consulting with the network
of stroke centers in Armenia. The Armenia Stroke
Council (ASC) was founded by ministerial order in July of
2019 as a collaborative international scientific advisory and
educational organization populated by several members of
SIATA and a selected group of neurologists and neurosurgeons
from Armenia with a proven track record in stroke
care and education. Although established by order of MOH,
the autonomy of ASC is fully respected by all stakeholders.
The first task of the ASC was to update acute stroke treatment
protocols and develop accreditation guidelines and
procedures for existing and future stroke centers. Based on
these guidelines, there are three comprehensive stroke centers
in Yerevan, and one recently activated thrombectomyready
center in Gyumri, the second largest city in Armenia.
Educating the general public and health professionals in
medical and nursing schools or during post-graduate training
are essential strategies to steer stroke-related statistics to
more favorable outcomes.14 Medical and nursing school curricula
regarding stroke education appear to need significant
modification. However, with the introduction of stroke protocols,
the neurology residents rotating at stroke centers now
have extended practical and didactic exposure to stroke. As a
result, stroke training at the residency level has greatly
improved during the last 2 years. Despite this progress, there
still is much room for improvement in the training programs.
There were no medical or surgical fellowship training programs
in Armenia that taught up-to-date stroke care until
recently. To close this gap, a Stroke Fellowship Program
(SFP) has been developed by the Department of Neurology
and Neurosurgery at the Armenia National Institute of Health
(ANIH), which functions under the umbrella of the MOH.
The SFP will be implemented in two phases. The first phase,
the Bridging Fellowship Program (BFP), is a one-time,
6-month, didactic, and practical program tailored mainly to
already practicing neurologists. Its goal is to provide additional
training in stroke care expediently and adequately. The
BFP was launched in March 2022 at the EMC. The EMC's
large number of stroke admissions, experienced staff, and
neuroimaging capabilities make it an effective learning
venue. The second phase of the SFP is designed as a 1-year
program, mainly tailored to graduating neurology residents.
It will eventually replace the BFP, providing more comprehensive
training. The curriculum of SFP reflects current scientific
concepts and clinical and interventional practices, and
it is prepared by an international faculty. It is approved by the
Department of Education of the ANIH and endorsed by the
ASC. Clinical research and participation in multicenter trials
are considered integral to the training program. The SFP will
train physicians from all regions of Armenia to staff the additional
stroke centers projected for the rest of the country.
Along with the TeleStroke program, these steps will mitigate
geographic and socioeconomic disparities in stroke care. The
scope of stroke nursing practice remains very limited in
Armenia, limiting nursing involvement in direct patient care.
In collaboration with an international faculty, a lecture series
was delivered for stroke nursing in January 2022. Substantial
improvements are still needed in nursing education and practice
to meet modern standards of stroke care, including ongoing
monitoring and stroke scale administration.
Public education and stroke advocacy
Public education regarding many aspects of stroke, from
prevention to prompt recognition of symptoms to the availability
of acute stroke treatments, is considered paramount
in staying ahead of the race against stroke.15 Television and
print and electronic media are being used to raise public
ESO East Supplement 2023

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