Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology · 2026
Real world outcomes of reperfusion treatments in acute ischemic stroke (AIS): a prospective cohort study.
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Chhatterpal Pinky, Vibha Deepti, Singh Rajesh Kumar, Pandit Awadh Kishor, Das Animesh, Elavarasi Arunmozhimaran, Bhatia Rohit, Srivastava Achal Kumar, Tripathi Manjari, Joseph Leve, Garg Ajay, Gaikwad Shailesh B
Аннотация
INTRODUCTION: Reperfusion Treatment(RT) options for Acute Ischemic Stroke(AIS) within 24 hours include: intravenous thrombolysis(IVT)(within 4.5 hours) and/or mechanical thrombectomy(MT). The utilization of benefits in 'real world' scenario, especially in Lower-Middle Income countries(LMICs) is not known. We aimed to determine the 'real-world' utilization and effectiveness of RT.
PATIENTS AND METHODS: In a single-center prospective cohort study, we collected data of all AIS patients coming within 24 hours. Patients receiving RT(IVT/MT/both) and those who were ineligible and received medical management (MM) were compared for the clinical, radiological characteristics and outcomes at 90-days assessed by modified Rankin Scale (mRS). The secondary outcomes were poor outcome at 90 days(mRS 3-6), Barthel Index(BI), Caregiver Strain Index(CSI), Stroke Specific Quality of Life(SSQoL) and mortality.
RESULTS: In the study period (January 2022-September 2023), there were 302 patients. The mean age was 55.9(SD:15.7) years and majority were males (64.9%). Patients who underwent RT (42.7%(129/302)) had similar clinical characteristics, except for lesser time to presentation, better Glasgow Coma Scale(GCS), and better median ASPECTS. IVT was given to 33.4%(101/302) and MT in 14.6%(44/302). The mRS at 90-days was significantly better in the RT group (RT:1(0;3), MM:3(1;5);P <0.001). RT was an independent protective factor (OR: 0.3(0.2;0.4); p-value:<0.001) for worse outcome (mRS 3-6). Other factors associated with mRS 3-6 at 90-days in multivariate analysis were high NIHSS and low ASPECTS at presentation.
CONCLUSIONS: RT is feasible and effective in LMICs. Since the burden of stroke is increasing in LMICs and mean age of stroke is lower, post-stroke disability prevention by RT is an important intervention.
PATIENTS AND METHODS: In a single-center prospective cohort study, we collected data of all AIS patients coming within 24 hours. Patients receiving RT(IVT/MT/both) and those who were ineligible and received medical management (MM) were compared for the clinical, radiological characteristics and outcomes at 90-days assessed by modified Rankin Scale (mRS). The secondary outcomes were poor outcome at 90 days(mRS 3-6), Barthel Index(BI), Caregiver Strain Index(CSI), Stroke Specific Quality of Life(SSQoL) and mortality.
RESULTS: In the study period (January 2022-September 2023), there were 302 patients. The mean age was 55.9(SD:15.7) years and majority were males (64.9%). Patients who underwent RT (42.7%(129/302)) had similar clinical characteristics, except for lesser time to presentation, better Glasgow Coma Scale(GCS), and better median ASPECTS. IVT was given to 33.4%(101/302) and MT in 14.6%(44/302). The mRS at 90-days was significantly better in the RT group (RT:1(0;3), MM:3(1;5);P <0.001). RT was an independent protective factor (OR: 0.3(0.2;0.4); p-value:<0.001) for worse outcome (mRS 3-6). Other factors associated with mRS 3-6 at 90-days in multivariate analysis were high NIHSS and low ASPECTS at presentation.
CONCLUSIONS: RT is feasible and effective in LMICs. Since the burden of stroke is increasing in LMICs and mean age of stroke is lower, post-stroke disability prevention by RT is an important intervention.