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Trends in stroke reperfusion treatment and outcomes in New Zealand.
Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Automatic control. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Landtblom: Neurology.ORCID iD: 0000-0002-5313-9052
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2019 (English)In: Internal medicine journal (Print), ISSN 1444-0903, E-ISSN 1445-5994Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) can help reverse stroke symptoms in selected patients but are both time sensitive interventions.

AIMS: To report current stroke reperfusion rates and quality measures as well as trends over time in New Zealand.

METHOD: Since 2015 New Zealand treatment centers have been mandated to prospectively enter all IVT and EVT patients into a low cost National Stroke Register. Data was cleaned and missing data added where possible through contact with individual hospitals. Main outcomes include treatment delays, vital status at day seven and complications.

RESULTS: In 2018, there were 719 of 7173 (10.0%) patients with ischemic stroke or stroke unspecified treated with intravenous IVT, up from 389 of 5963 (6.5%) patients in 2015 (p < 0.001), with no change in day seven mortality (p = 0.63) or sICH rate (p = 0.22). Median (interquartile range (IQR)) door-to-needle times decreased from 65 (47-89) minutes in 2017 to 59 (40-84) minutes in 2018 (p = 0.022), and patients treated within 60 min increased from 40% to 51% (p < 0.001). In 2018, there were 243 (3.4%) patients treated with EVT up from 134/6859 (1.9%) in 2017 (p < 0.0001), with no change in seven mortality (p = 0.39) or sICH (p = 0.78). There was no significant change in onset-to-needle (p = 0.21), arrival-to-groin (p = 0.28) or onset-to-reperfusion time (p = 0.32).

CONCLUSION: Stroke reperfusion rates in New Zealand are continuously rising with no associated increase in complications. More patients are being treated faster upon hospital arrival but there remains room for further improvement in reducing onset to treatment delays. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
2019.
Keywords [en]
Endovascular Clot Retrieval, Ischaemic Stroke, Mechanical Thrombectomy, Reperfusion, Stroke, Thrombolysis
National Category
Neurology
Identifiers
URN: urn:nbn:se:uu:diva-401400DOI: 10.1111/imj.14682PubMedID: 31707750OAI: oai:DiVA.org:uu-401400DiVA, id: diva2:1383339
Available from: 2020-01-07 Created: 2020-01-07 Last updated: 2020-01-07

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