Prehospital and intra-hospital time delays in posterior circulation stroke: results from the Austrian Stroke Unit Registry.
Therapeutic effect of recombinant tissue-plasminogen activator (rt-PA) is time dependent. There is limited evidence whether localization of stroke within the posterior circulation (PCS) is associated with a treatment delay. We aimed to analyze within a nationwide multicenter cohort whether duration of pre- and intra-hospital patient management differs between patients with PCS and anterior circulation strokes (ACS). We studied onset-to-door-times (ODT) and door-to-needle-times (DNT) of all patients with acute ischemic stroke (IS) enrolled in the Austrian Stroke Unit Registry according to infarct localization. Classification into PCS and ACS was based on clinical presentation applying the criteria used in the Oxfordshire Community Stroke Project. Relationships between ODT, respectively, DNT and explanatory variables were modeled by multivariate linear regression. Between 2003 and 2015, 71010 patients with IS were enrolled, 11,924 with PCS and 59,086 with ACS. Overall, the ODT was significantly longer in PCS: median (IQR): 170 (25th, 75th‰: 79,420) min versus 110 (60,240); p < 0.001; this finding held true in multivariable analysis. In 10535 rt-PA-treated patients (1022 PCS/9832 ACS), ODT and DNT were significantly longer among those with PCS: ODT: median: 80 min (55,120) versus 72 (50,110), p < 0.001; DNT: 57 (35.90) versus 45 (30.67), p < 0.001. In the multivariate model, PCS was significantly associated with delay in the DNT. In conclusion, in this large nationwide cohort, patient management was significantly slower in PCS as compared to ACS. Increasing awareness about these delays and further elaboration of the underlying causes may translate into higher proportions of patients with PCS receiving rt-PA.
Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Peter
P
Sommer
Danube University Krems and Gesundheit Österreich GmbH/BIQG, Vienna, Austria.
Leonhard
L
Seyfang
Danube University Krems and Gesundheit Österreich GmbH/BIQG, Vienna, Austria.
Alexandra
A
Posekany
Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria.
Julia
J
Ferrari
Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria.
Wilfried
W
Lang
Department of Neurology, Krankenanstalt Rudolfstiftung, Vienna, Austria.
Elisabeth
E
Fertl
Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
Wolfgang
W
Serles
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Thomas
T
Töll
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Stefan
S
Kiechl
Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. stefan.greisenegger@meduniwien.ac.at.
Stefan
S
Greisenegger
D000368:Aged; D000369:Aged, 80 and over; D001317:Austria / Q000453:epidemiology; D002545:Brain Ischemia / Q000145:classification / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012042:Registries; D020521:Stroke / Q000145:classification / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D014187:Transportation of Patients / Q000706:statistics & numerical data
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
All cerebrovascular disease/stroke; Cohort studies; Infarction; Intravenous thrombolysis; Posterior circulation stroke