STROKE ON THE FRONTIER: EXECUTION AND OUTCOMES OF INTRAVENOUS THROMBOLYSIS IN A FINNISH PERIPHERAL PRIMARY STROKE CENTER

• Format: Other/Unknown Material
• Language: English
• Published: Morressier 2017
• Subjects: demo; socio; karelia*
• Online Access: https://doi.org/10.26226/morressier.5cb58d00c668520010b56fa2; https://openresearchlibrary.org/ext/api/media/602c40fc-4810-4ba0-9920-de0480b56535/assets/external_content.pdf; https://openresearchlibrary.org/viewer/602c40fc-4810-4ba0-9920-de0480b56535

Background: Advances in mechanical thrombectomy (MT) have resulted in uncertainty about the status of primary stroke centers (PSC) where only intravenous thrombolysis (IVT) is available and their outcome was therefore investigated.Methods: Patients treated with IVT at North Karelia Central Hospital, a PSC serving a population of 165u2019569 in Joensuu, on the eastern border of Finland and the EU, were identified out of all the 570 cerebral infarct ward discharges in 2016-2017. Data was retrospectively gathered from electronic patient records. Joensuu is two hours away from the nearest comprehensive stroke center at Kuopio University Hospital.Results: Altogether 75 IVTs (47% women) were identified. Median age was 74 years (IQR 64; 81) with no gender difference (p=0.70). Before the stroke, 85% had been totally independent. Median NIHSS (N=72) was 6 (IQR 4;10, range 0-25) and OTT 125 minutes (N=67, 95% CI 112-138 min, range 43-270 min, graph 1). Clinical status improved following IVT (table) and the majority were independent at six months (graph 2). LVO was identified in 27% and MT followed IVT in 30% of these. In the LVO patients the mean mRS was 3.0 (1.8 in those alive, 25% had died). Only LVO and pre-IVT NIHSS score predicted the mRS (gender, age and OTT did not) and in a multivariate analysis the NIHSS was the sole predictor (B=0.12, R2=0.34, p=0.0001).Conclusion: This peripheral PSCu2019s IVT results were good, but LVO outcomes need improvement.