Submit Manuscript  

Article Details


Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A “Real-world” Study in a Developing Country

[ Vol. 17 , Issue. 4 ]

Author(s):

Victor C. Schulz*, Pedro S.C. de Magalhaes, Camila C. Carneiro, Julia I.T. da Silva, Vivian N. Silva, Vanessa V. Guesser, Juliana Safanelli, Henrique Diegoli, Rafaela B. Liberato, Cristiane C.C. Lopes, Aline de Souza, Paulo H.C. de França, Adriana B. Conforto and Norberto L. Cabral   Pages 361 - 375 ( 15 )

Abstract:


Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the “real world” scenario of low and middle-income countries. We aimed to measure the long-term outcomes of severe IS treated or not with CRT in Brazil.

Methods: Patients from a stroke center of a state-run hospital were included. We compared the survival probability and functional status at 3 and 12 months in patients with severe IS treated or not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined or not with intravenous alteplase (IAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in 2012-2017 did not undergo CRT (NCRT group).

Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19% (178/917) in the IVT group and 7% (62/917) in the IAT group. Compared to the NCRT group, IVT patients had a 28% higher (HR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91). For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41; 95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95% CI 0.66-094). These outcomes remained significantly better throughout the first year.

Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.

Keywords:

Stroke, cerebral reperfusion, thrombolysis, mechanical thrombectomy, functional dependence, intra-arterial treatment.

Affiliation:

Post-Graduation Program on Health and Environment, University of the Region of Joinville, Santa Catarina 88330- 622, Department of Neurology, Hospital Municipal Sao Jose, Joinville, Post-Graduation Program on Health and Environment, University of the Region of Joinville, Santa Catarina 88330- 622, Department of Medicine, University of the Region of Joinville, Joinville, Department of Neurology, Hospital Municipal Sao Jose, Joinville, Department of Neurology, Hospital Municipal Sao Jose, Joinville, Department of Neurology, Hospital Municipal Sao Jose, Joinville, Department of Neurology, Hospital Municipal Sao Jose, Joinville, Department of Neurology, Hospital Municipal Sao Jose, Joinville, Post-Graduation Program on Health and Environment, University of the Region of Joinville, Santa Catarina 88330- 622, Department of Neurology, Hospital Municipal Sao Jose, Joinville, Post-Graduation Program on Health and Environment, University of the Region of Joinville, Santa Catarina 88330- 622, Hospital das Clínicas, Sao Paulo University, Sao Paulo, Post-Graduation Program on Health and Environment, University of the Region of Joinville, Santa Catarina 88330- 622



Read Full-Text article