Abstract TP242: Intravenous rt-PA Therapy for Acute Ischemic Stroke in the Kagawa Prefecture in Japan -Results and Patient Characteristics

Abstract

Background and Purpose: The Kagawa prefecture is the region of Japan with the highest utilization rate of intravenous (i.v.) rt-PA treatment per 100,000 people over the age of 65. We retrospectively reviewed patient characteristics and results of this therapy for seven stroke centers in the Kagawa prefecture over the last three years. Methods: 273 patients received i.v. rt-PA treatment between January 1, 2009 and December 31, 2011. Stroke subtype, NIHSS at admission, mRS (modified Rankin Scale) at discharge, mRS by each obstructed artery, incidence of symptomatic intracranial hemorrhage (sICH), and location at the onset were recorded for all patients. Results: The mean age was 73.9 years and male/female ratio was 1.55. The proportion of cardioembolic stroke was 53.1%. The mean baseline NIHSS was 13.8 points. Excellent outcome (mRS 0 to 1) at discharge was present in 19.2%, favorable outcome (mRS 0 to 2) in 31.4%, and poor outcome (mRS 5 to 6) in 31.0%. The overall mortality (mRS 6) was 11.4% and sICH occurred in 5.1%. Cardiogenic infarction had less favorable outcomes than other stroke subtypes. Excellent outcome was achieved in 29.0% of M2 occlusions, 9% in Ml occlusions and 5.9% in ICA occlusions. Patients with ICA occlusion had the worst prognosis with poor outcome in 55.9% compared to 43.3% for Ml occlusion and 18.4% for M2 occlusion. The mortality of ICA occlusion was 35.3%. Conclusions: Our patient background and safety characteristics (such as incidence of sICH and mortality) are comparable to the Japanese J-MARS post-marketing surveillance study. However, our outcomes are less favorable than those in previous reports. Cardiogenic infarction and major artery occlusion (such as Ml or ICA) are particularly poor prognostic factors. Sixteen neurological institutes can administer i.v. rt-PA treatment in Kagawa, all with access to MRI scanners 24/7. Despite this excellent medical environment, problems remain related to regional and topographic factors such as patients living on islands and mountainous areas. In this study, we report the challenges, treatment strategies and results for the treatment of acute stroke in the Kagawa prefecture.