RESEARCH – May 2018

Current status of stroke revascularization therapy in Estonia

Authors: Kadri Eerik, Riina Vibo, Andrus Kreis, Janika Kõrv

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Abstract

Background. Stroke is the second leading cause of death and a major cause of disability worldwide. Stroke treatment has evolved substantially over the last decades. Standard medical care with intravenous tPA improves survival and functional outcomes when administered < 4,5 hours after stroke onset, but its effect is limited for patients with proximal large arterial occlusions. Randomized clinical trials have proven mechanical thrombectomy to be a highly effective and safe treatment in acute ischemic stroke caused by a proximal intracranial occlusion. The aim of this study was to analyze the results of mechanical thrombectomy in Estonia from 2015 to 2017.

Methods. Data were collected from the Safe Implementations of Treatments in Stroke (SITS) registry. Patients treated with mechanical thrombectomy in 2015-2017 were included from two regional hospitals of Estonia. Anonymous data on demographic details, stroke risk factors, National Institutes of Health Stroke Scale (NIHSS) scores, procedural times, treatment details and outcomes at 90 days (modified Rankin Scale, mRS) were collected for each patient. Data were analyzed using Microsoft Excel and R version 3.4.3. programs and significance was defined as a P value of 0,05.

Results. From a total of 338 mechanical thrombectomies performed in Estonia, 287 (84,9 %) were reported in SITS registry and included in this study. From these, 200 thrombectomies were performed in North Estonia Medical Centre and 87 in Tartu University Hospital. The number of thrombectomies increased every year. Median age was 72 (18-91) years and 48,4 % were female. Median NIHSS score on hospital admission was 17 (0-37). Mechanical thrombectomy procedural times reduced every year. Patients with shorter procedural times and successful recanalization had better functional outcomes.

Conclusions. Our analysis gives an overview of stroke revascularization therapy in Estonia in 2015-2017. Mechanical thrombectomy procedural times reduced every year. Patients with shorter procedural times and successful recanalization had better functional outcomes. Our findings on procedural times, efficacy and safety are comparable with similar studies. Strategy of stroke management including thrombectomy, should be settled together with National Health Insurance Fund, Ministry of Social Affairs and professional societies with the aim to provide equal treatment facilities to all stroke patients despite of geographical differences.