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

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ESOC-2019

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Abstract

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 165’569 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 PSC’s IVT results were good, but LVO outcomes need improvement.

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© Copyright 2019 Morressier GmbH.
All rights reserved.