Outcomes of Acute Ischemic Stroke Patients Undergoing Revascularization Treatment at a Tertiary Care Centre in North India: A Real World Prospective Cohort Study
Pinky Chhatterpal1, Deepti Vibha1, Manjari Tripathi1, Rohit Bhatia1, Achal Srivastava1, Awadh Pandit1, Rajesh Kumar1, Ajay Garg2, Shailendra Gaikwad2, Leve Joseph2, Vishnu Vy1, Padma Srivastava1
1NEUROLOGY, 2NEURORADIOLOGY AND NEUROINTERVENTION, ALL INDIA INSTITUTE OF MEDICAL SCIENCES, NEW DELHI
Objective:

There is lack of literature on real world outcomes after reperfusion therapies (RT) in Acute ischemic stroke (AIS) in developing countries. We aimed to measure improvement in functional outcomes of AIS treated RT in India.

Background:
Acute ischemic stroke (AIS) is the major stroke type contributing to over 85% of all strokes. The patients presenting within the first few hours have the highest chance of benefit with definitive treatment in the form of thrombolysis or thrombectomy.
Design/Methods:

Demographic, clinical, imaging data of AIS patients within 24 hours of ictus collected. The diagnosis established clinically and confirmed by neuroimaging. The comparative groups those who received RT (intravenous thrombolysis and/or mechanical thrombectomy) versus those who were ineligible for RT. The information on risk factors, time to presentation, ASPECTS and intervention given collected. The primary outcome was modified rankin score (mRS) at 3months. The secondary outcomes were quality of life on the basis of caregiver burden scale, Barthel index and Stroke Specific Quality of Life (SSQoL).

Results:

From January 2022 to September 2023, 405 patients were screened,103 patients excluded (Intracerebral Hemorrhage (93/103(90.3%)), cerebral venous thrombosis (4/103(3.9%)), transient ischemic attack (3/103(2.9%)), Sulcal SAH(1/103(0.1%)) and Todd’s palsy (1/103 (0.1%)). Out of 302 patients, 127(42.1%) received RT and 175 (57.9%) received medical management (MM) due to clinico-radiological indications. Good outcome(mRS 0-2) at discharge was 30.3%(53/175) in MM and 33.0%(42/127) in intervention group (p-value: 0.72). At 3months, significant improvement mRS 0-2 was present in 42.2%(74/175) in MM group and 67.1%(92/127) in intervention group(p-value <0.001).

Conclusions:

This study provides the feasibility of RT and better outcomes in resource limited settings. However, these patients presented with favourable characteristics (less median time to presentation, better ASPECT). This emphasizes the need to stroke awareness programmes at community level, so that more patients can receive RT and have better outcomes.

10.1212/WNL.0000000000208410
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