title: Rate of intravenous thrombolysis for acute ischaemic stroke in the North-of-France region and evolution over time.
abstract: The proportion of patients with ischaemic stroke treated by intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is an indicator of quality of stroke care. The objective of the study is to evaluate the rate of i.v. thrombolysis in the North-of-France region and its evolution over time. We determined the proportion of inhabitants treated by i.v. rt-PA in 2009-2010 (period A; 8 stroke units, no telemedicine) and 2012 (period B; population campaigns, 12 stroke units with telemedicine in 5). We used hospital registries from the 12 stroke units, and population-based data were collected in a subpopulation of 226,827 inhabitants (5.6% of the whole population). 1,563 inhabitants received i.v. rt-PA for stroke (period A: 835 in 24 months; period B: 728 in 12 months). Hospital and population data were similar. Annual rates of thrombolysis increased from 103 per million inhabitants [95% confidence interval (CI) 85-125] to 181 (95% CI 157-209; relative increase 76%, 95% CI 67-83%). This rate increased in 12 districts (significantly in 6), but the increase was greater in districts where new stroke units, telemedicine, or both were implemented. In conclusion, although the proportion of patients treated was already high in period A, there was still place for improvement. Implementation of new stroke units, extension of the telemedicine network and new population campaigns are necessary to improve the rate of thrombolysis in several areas, to ensure an equal access to treatment over the whole territory. The next step is now to determine whether this high rate of i.v. rt-PA delivery at the population level translates into clinical results.
authors.affiliation: Stroke Unit, Neurology Department, Lille University Hospital, Lille, France.
authors.forename: N
authors.initials: N
authors.lastname: Dequatre-Ponchelle
authors.forename: H
authors.initials: H
authors.lastname: Touzani
authors.forename: A
authors.initials: A
authors.lastname: Banh
authors.forename: I
authors.initials: I
authors.lastname: Girard-Buttaz
authors.forename: R
authors.initials: R
authors.lastname: Coche
authors.forename: P
authors.initials: P
authors.lastname: Dobbelaere
authors.forename: C
authors.initials: C
authors.lastname: Cordonnier
authors.forename: M
authors.initials: M
authors.lastname: Girot
authors.forename: P
authors.initials: P
authors.lastname: Aguettaz
authors.forename: F
authors.initials: F
authors.lastname: Mounier-Vehier
authors.forename: E
authors.initials: E
authors.lastname: Wiel
authors.forename: N
authors.initials: N
authors.lastname: Bronet
authors.forename: E
authors.initials: E
authors.lastname: Josien
authors.forename: P
authors.initials: P
authors.lastname: Duhamel
authors.forename: M
authors.initials: M
authors.lastname: Mihout
authors.forename: A
authors.initials: A
authors.lastname: Maisonneuve
authors.forename: A
authors.initials: A
authors.lastname: Mackowiak
authors.forename: M
authors.initials: M
authors.lastname: Bodenant
authors.forename: P
authors.initials: P
authors.lastname: Williatte
authors.forename: X
authors.initials: X
authors.lastname: Leclerc
authors.forename: C
authors.initials: C
authors.lastname: Lefebvre
authors.forename: O
authors.initials: O
authors.lastname: Nigeon
authors.forename: P
authors.initials: P
authors.lastname: Devos
authors.forename: G
authors.initials: G
authors.lastname: Duncan
authors.forename: G
authors.initials: G
authors.lastname: Malanda
authors.forename: B
authors.initials: B
authors.lastname: Majed
authors.forename: O
authors.initials: O
authors.lastname: Dereeper
authors.forename: V
authors.initials: V
authors.lastname: Pégoraro
authors.forename: T
authors.initials: T
authors.lastname: Rosolacci
authors.forename: P
authors.initials: P
authors.lastname: Alarcon
authors.forename: E
authors.initials: E
authors.lastname: Koral
authors.forename: M
authors.initials: M
authors.lastname: Pasquini
authors.forename: S
authors.initials: S
authors.lastname: Verclytte
authors.forename: J B
authors.initials: JB
authors.lastname: N'Kuendjo
authors.forename: J B
authors.initials: JB
authors.lastname: Campagne
authors.forename: P
authors.initials: P
authors.lastname: Le Coz
authors.forename: J
authors.initials: J
authors.lastname: Devienne
authors.forename: Z
authors.initials: Z
authors.lastname: Seth
authors.forename: R
authors.initials: R
authors.lastname: Tholliez
authors.forename: H
authors.initials: H
authors.lastname: Hénon
authors.forename: G
authors.initials: G
authors.lastname: Smith
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.forename: F
authors.initials: F
authors.lastname: Agbemebia
authors.forename: J M
authors.initials: JM
authors.lastname: Behra
authors.forename: D
authors.initials: D
authors.lastname: Pollet
authors.forename: P
authors.initials: P
authors.lastname: Coffin
authors.forename: P
authors.initials: P
authors.lastname: Lavau
authors.forename: A
authors.initials: A
authors.lastname: Vérier
authors.forename: C
authors.initials: C
authors.lastname: Lucas
authors.forename: N
authors.initials: N
authors.lastname: Smaiti
authors.forename: P
authors.initials: P
authors.lastname: Dalinval
authors.forename: J
authors.initials: J
authors.lastname: Dallongeville
authors.forename: P
authors.initials: P
authors.lastname: Valette
authors.forename: J P
authors.initials: JP
authors.lastname: Pruvo
authors.forename: P
authors.initials: P
authors.lastname: Goldstein
authors.forename: D
authors.initials: D
authors.lastname: Leys
mesh_terms: D061605:Administration, Intravenous / Q000379:methods*; D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000150:complications*; D005602:France; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology*; D017216:Telemedicine; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
chemical_list: D010959:Tissue Plasminogen Activator
references.citation: J Hosp Med. 2010 Sep;5(7):406-9
references.pmid: 20578049
references.citation: Stroke. 2009 Dec;40(12):3841-4
references.pmid: 19875743
references.citation: Cerebrovasc Dis. 2000;10 Suppl 4:17-20
references.pmid: 11070394
references.citation: Cerebrovasc Dis. 2007;23(5-6):344-52
references.pmid: 17268165
references.citation: BMC Neurol. 2011 Jan 06;11:2
references.pmid: 21211051
references.citation: Stroke. 2006 Feb;37(2):440-6
references.pmid: 16397164
references.citation: Cerebrovasc Dis. 2008;25(5):457-507
references.pmid: 18477843
references.citation: J Neurol Neurosurg Psychiatry. 2011 Jan;82(1):14-9
references.pmid: 20581132
references.citation: Cerebrovasc Dis. 2009;27 Suppl 4:V-VI
references.pmid: 19546534
references.citation: J Neurol. 2009 Jun;256(6):867-73
references.pmid: 19252801
references.citation: Stroke. 2002 Jan;33(1):153-9
references.pmid: 11779905
references.citation: Stroke. 2010 Sep;41(9):1984-9
references.pmid: 20651262
references.citation: Arch Neurol. 2006 May;63(5):661-4
references.pmid: 16682535
references.citation: Int J Stroke. 2009 Jun;4(3):187-99
references.pmid: 19659821
references.citation: Stroke. 2009 Dec;40(12):3845-50
references.pmid: 19797697
references.citation: Acta Neurol Scand. 2010 Oct;122(4):229-36
references.pmid: 19919643
references.citation: Lancet. 2007 Jan 27;369(9558):275-82
references.pmid: 17258667
references.citation: Stroke. 2011 Jul;42(7):1952-5
references.pmid: 21636813
references.citation: Lancet. 2008 Oct 11;372(9646):1303-9
references.pmid: 18790527
references.citation: Lancet. 2012 Jun 23;379(9834):2352-63
references.pmid: 22632908
references.citation: Lancet. 1997 Jun 7;349(9066):1641-9
references.pmid: 9186381
references.citation: Lancet. 1997 May 31;349(9065):1569-81
references.pmid: 9174558
references.citation: Med J Aust. 2011 Feb 7;194(3):111-5
references.pmid: 21299483
references.citation: CMAJ. 2005 May 10;172(10):1307-12
references.pmid: 15883405
references.citation: N Engl J Med. 1995 Dec 14;333(24):1581-7
references.pmid: 7477192
references.citation: Stroke. 2007 Nov;38(11):2985-91
references.pmid: 17901388
references.citation: J Neurol. 2013 Feb;260(2):635-9
references.pmid: 23052603
references.citation: Lancet Neurol. 2007 Mar;6(3):215-22
references.pmid: 17303527
references.citation: Lancet. 1993 Aug 14;342(8868):395-8
references.pmid: 8101901
references.citation: Acta Neurol Belg. 2010 Jun;110(2):157-62
references.pmid: 20873445
references.citation: J Neurol Neurosurg Psychiatry. 2012 Feb;83(2):227-8
references.pmid: 21172859
references.citation: Cerebrovasc Dis. 2010;30(2):148-56
references.pmid: 20551630
references.citation: Lancet. 2010 May 15;375(9727):1695-703
references.pmid: 20472172
references.citation: Stroke. 2012 Aug;43(8):2086-90
references.pmid: 22693132
references.citation: N Engl J Med. 2008 Sep 25;359(13):1317-29
references.pmid: 18815396