Short door-to-needle times in acute ischemic stroke: Report of 2 cases from UAE

Abstract

Median Door-to-Needle (DTN) time ≤ 60 minutes in acute ischemic stroke is recommended by AHA/ASA. We present 2 patients with DTN time ≤ 23 minutes. 54 year old man with a background history of hypertension, ischemic heart disease, chronic kidney disease presented with acute onset speech difficulty and numbness right hand. NIHSS on admission was 6. CT brain showed dense left MCA sign. Patient came within window period for thrombolysis. rtpA was given. DTN time was 23 minutes. Post rtpA he developed hypertension which controlled with medicaiton. NIHSS post-rtpA was 2. MRI showed acute left MCA infarct. At discharge he was on dual antiplatelet, statin and antihypertensives. mRS at discharge was 0. 52 year old man with background history of CABG with poor compliance to Aspirin presented with acute onset dizziness and inability to walk. Exam showed significant ataxia. CT brain was normal. Patient came within window period for thrombolysis. rtpA was given. DTN time was 21 minutes. Post rtpA, there were no complications. NIHSS post-rtpA was 2. MRI showed acute right pontine infarct. At discharge he was on dual anti platelet and statin. mRS at discharge was 0 “Acute Stroke Clinical Pathway” in Al Ain hospital was designed in 2015 and is updated periodically. Successful implementation of this pathway is key in achieving short DTN times. We present the first reports of short DTN times in UAE thus reflecting the efficiency of our Stroke Code team.