Patterns and outcomes of stroke thrombolysis in a large tertiary care hospital in Riyadh, Saudi Arabia - Single center experience

Abstract

Thrombolysis in acute ischemic stroke although being standard of care is still significantly underutilized. There is no published data from Saudi Arabia about the use and outcomes of thrombolysis in stroke. To present single center experience of stroke thrombolysis from a tertiary care center in Riyadh, KSA. An IRB approved cross-sectional, observational study of patients receiving thrombolysis between January 2012 and December 2018. A total of 148 patients received thrombolysis, 94 (63%) were men; mean age 58.2 + 14.5years. Mean time from stroke onset to hospital arrival was 89 + 48 minutes; 25% arrived within one hour. Mean NIHSS score on admission was 13.4. Hypertension (68.9%), diabetes (56.1%), and dyslipidemia (40.5%) were commonest risk factors. Cardioembolism was the commonest mechanism of stroke (43.2%) and was associated with more severe presentation (p=0.031). Intravenous thrombolysis alone was given to 98 (66.2%); the rest had IV tPA and endovascular therapy or endovascular therapy alone. Mean door-to-needle time was 79.7 minutes, showing significant improvement between 2012 (111.6 minutes) and 2018 (69.9 minutes); p-value <0.001. Good outcome (mRS of 0-2) was seen in 35.8%, whereas 14 (9.5%) patients died. Symptomatic ICH was seen in 11.5%. All vascular risk factors were more common in age > 60 years except smoking which was more common in younger (p = 0.007). In our cohort, high frequency of vascular risk factors was seen. One-third of patients received endovascular treatment. The mean door-to-needle time improved significantly over years. Cardioembolic strokes were the most frequent and more severe.