Fredrik Hedlund1,2, Andrew Leighs1, P Alan Barber3, Erik Lundström2, Teddy Y Wu4, Annemarei Ranta1. 1. Department of Medicine, University of Otago, Wellington, New Zealand. 2. Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden. 3. Department of Medicine, University of Auckland, Auckland, New Zealand. 4. Department of Neurology, Christchurch Hospital, Christchurch, New Zealand.
Abstract
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 centres have been mandated to enter prospectively all IVT and EVT patients into a low-cost National Stroke Register. Data were cleaned, and missing data added where possible through contact with individual hospitals. Main outcomes include treatment delays, vital status at day 7 and complications. RESULTS: In 2018, there were 719 of 7173 (10.0%) patients with ischaemic stroke or stroke unspecified treated with IVT, up from 389 of 5963 (6.5%) patients in 2015 (P < 0.001), with no change in day 7 mortality (P = 0.63) or sICH rate (P = 0.22). Median (interquartile range (IQR)) door-to-needle times decreased from 65 (47-89) min in 2017 to 59 (40-84) min 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 7-day mortality (P = 0.39) or intracerebral haemorrhage (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.
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 centres have been mandated to enter prospectively all IVT and EVT patients into a low-cost National Stroke Register. Data were cleaned, and missing data added where possible through contact with individual hospitals. Main outcomes include treatment delays, vital status at day 7 and complications. RESULTS: In 2018, there were 719 of 7173 (10.0%) patients with ischaemic stroke or strokeunspecified treated with IVT, up from 389 of 5963 (6.5%) patients in 2015 (P < 0.001), with no change in day 7 mortality (P = 0.63) or sICH rate (P = 0.22). Median (interquartile range (IQR)) door-to-needle times decreased from 65 (47-89) min in 2017 to 59 (40-84) min 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 7-day mortality (P = 0.39) or intracerebral haemorrhage (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.
Authors: Jason J Wang; Casey E Pelzl; Artem Boltyenkov; Jeffrey M Katz; Jennifer Hemingway; Eric W Christensen; Elizabeth Rula; Pina C Sanelli Journal: J Am Coll Radiol Date: 2022-04-25 Impact factor: 6.240
Authors: Stephanie G Thompson; P Alan Barber; John H Gommans; Dominique A Cadilhac; Alan Davis; John N Fink; Matire Harwood; William Levack; Harry K McNaughton; Valery L Feigin; Virginia Abernethy; Jacqueline Girvan; Joosup Kim; Hayley Denison; Marine Corbin; Andrew Wilson; Jeroen Douwes; Annemarei Ranta Journal: Neurology Date: 2022-05-27 Impact factor: 11.800