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.
[http://dx.doi.org/10.1056/NEJMoa1411587] [PMID: 25517348]
[http://dx.doi.org/10.1056/NEJMoa1414905] [PMID: 25671798]
[http://dx.doi.org/10.1056/NEJMoa1414792] [PMID: 25671797]
[http://dx.doi.org/10.1056/NEJMoa1415061] [PMID: 25882376]
[http://dx.doi.org/10.1056/NEJMoa1503780] [PMID: 25882510]
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.116] [PMID: 28038899]
[http://dx.doi.org/10.1111/ene.12944] [PMID: 26850793]
[http://dx.doi.org/10.1377/hlthaff.2010.0666] [PMID: 20921481]
[http://dx.doi.org/10.1016/S0140-6736(07)61696-1] [PMID: 18063029]
[http://dx.doi.org/10.1016/S0140-6736(18)31221-2] [PMID: 30037735]
[http://dx.doi.org/10.1111/ijs.12062] [PMID: 23692595]
[http://dx.doi.org/10.1016/S1474-4422(19)30068-7] [PMID: 31029579]
[http://dx.doi.org/10.1590/0004-282x20170178] [PMID: 29364389]
[http://dx.doi.org/10.1016/j.ensci.2016.04.002] [PMID: 29430550]
[http://dx.doi.org/10.1159/000445060] [PMID: 27064414]
[http://dx.doi.org/10.1161/01.STR.20.7.864] [PMID: 2749846]
[http://dx.doi.org/10.1016/0140-6736(91)93206-O] [PMID: 1675378]
[http://dx.doi.org/10.1161/01.STR.24.1.35] [PMID: 7678184]
[http://dx.doi.org/10.1016/S0140-6736(00)02237-6] [PMID: 10905241]
[http://dx.doi.org/10.1016/S0196-0644(99)70299-4] [PMID: 10092713]
[http://dx.doi.org/10.1590/S0004-282X2012001100012] [PMID: 23175203]
[http://dx.doi.org/10.1056/NEJMoa0804656] [PMID: 18815396]
[http://dx.doi.org/10.3174/ajnr.A0843] [PMID: 18337393]
[http://dx.doi.org/10.1161/01.STR.32.6.1330] [PMID: 11387495]
[http://dx.doi.org/10.1161/01.STR.30.8.1538] [PMID: 10436097]
[http://dx.doi.org/10.1159/000367646] [PMID: 25412853]
[http://dx.doi.org/10.1212/WNL.0000000000006554] [PMID: 30341155]
[http://dx.doi.org/10.1016/j.wneu.2020.03.105] [PMID: 32229302]
[http://dx.doi.org/10.7861/fhj.2019-0003] [PMID: 32104769]
[http://dx.doi.org/10.1007/s00415-020-09778-4] [PMID: 32140863]
[http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2016.11.128] [PMID: 28065616]
[http://dx.doi.org/10.1111/ene.13931] [PMID: 30748047]
[http://dx.doi.org/10.4103/0028-3886.136919] [PMID: 25033849]
[http://dx.doi.org/10.1007/s13760-015-0552-7] [PMID: 26445955]
[http://dx.doi.org/10.1177/1747493018806199] [PMID: 30346260]