Improved Outcomes after Reperfusion Therapies for Ischemic Stroke: A “Real-world” Study in a Developing Country

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: 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.

Treatments in Ischemic Stroke: Current and Future

“…EVT with MT within 6 h from symptom onset is known to be safe and effective in reducing neurological disability when administered in AIS patients affected by a large cerebral artery occlusion [22][23][24][25][26]. However, only 10-20% of stroke patients are eligible for EVT; besides, access to thrombectomy centers in less than 6 h after symptom onset is not feasible in many parts of the world [47][48][49]. Moreover, even in case of a successful recanalization of the occluded vessel, the clinical outcome may still be poor, a phenomenon called "futile recanalization," and this is still notable defy of EVT [50].…”

Internet das Coisas de Saúde: aplicando IoT, interoperabilidade e aprendizado de máquina com foco no paciente

“…Este programa traz resultados positivos na atenção primária através de prevenção (redução de 36.4% na incidência de AVC) [33], de melhores desfechos em pacientes acometidos pelo AVC (aumento de 49% na melhora funcional em casos de AVC grave), da redução da letalidade (redução de 47% após 5 anos) e da redução dos custos totais da intervenção completa [34]. Outro importante fator para o sucesso deste programa é a adaptação e o refinamento de terapias a partir da utilização e aplicação de "dados de mundo real", ou seja, utilização de dados relacionados ao estado de saúde de pacientes coletados na rotina de atendimento da população local [35].…”