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:
There were included patients from a stroke center of a state-run hospital. 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 a risk of functional dependence 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, 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.
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