Acute stroke care: Experience of a tertiary care center in Delhi, the way to go

Abstract

Stroke is one of the leading cause of death and disability in India. However providing acute stroke care including IV Thrombolysis and Mechanical thrombectomy remains a challenge due to paucity of stroke centers and poor public awareness about symptoms of stroke and available treatment options. We analyzed our data of patients of acute stroke admitted in last two years. 932 patients of acute stroke were admitted between December’2017 to December’2018. 673(72.21%) were male and 259 (27.7) female. Of these 710 were ischemic strokes (76.18%) and 222 were haemorrhagic (23.81%). Average age of the patients was 62 years with a range of 15 yrs. to 90 years. 107 patients were < 45 years of age (11.4%), which corroborates with Asian data. The average NIHSS was 8 with range of 2 to 23. 184 patients (19.7%) were thrombolysed with IV TPA, which is a high number when compared with nationwide data. Average door to needle time was 48 min with a lowest of 4 min. Another major finding was outcome at 3 months with Modified Rankin Scale of 0–1 in 60% of patients. 36 patients had large artery occlusion, of which 23 had M1 MCA occlusion, 9 had Tandem occlusion and 4 had T-occlusion. These patients underwent mechanical thrombectomy using Solitaire device in addition to IV thrombolysis. Of these 25 (69.4%)had significant improvement with mRS of 0–1 at 3 months. Although our data has shown encouraging findings, there is still a long way to go.