[Acute stroke treatment in Landspitali University hospital - current status and future aims].

Abstract

Background: Advances in acute stroke care including specialized stroke units, intraveneous thrombolysis and mechanical thrombectomy for ischemic stroke, and prompt blood pressure reduction in intracerebral hemorrhage, have significantly reduced its devasting consequences. This study investigates acute stroke care quality at Landspitali University Hospital in Iceland (LUH).

Method: Retrospective, cross-sectional study describing the cohort of stroke patients seeking emergency treatment at LUH in 2022, comparing the quality of provided treatment to benchmarks set in neighbouring countries.

Results: Among 337 adult ischemic strokes and 71 intracerebral hemorrhages, the mean age was 70,7 (SD: 14,4); 72,6% arrived to LUH within six hours of onset. Baseline NIHSS was documented in 29,8% and 24,3% received a CT scan within15 minutes. Revascularisation therapy was given to 17,8% of ischemic strokes. Median door-to-needle and door-to-puncture times were 31 and 93 minutes with thrombolysis and thrombectomy, respectively; 69% of thrombectomies achieved a good reperfusion grade (mTICI 2b-3). In cases of intracerebral hemorrhage, 57,9% had documented systolic blood pressure targets, with 36,0% aiming for <160 mmHg and 17,2% for <140 mmHg. Anticoagulation was associated with 19,7% of these hemorrhages, of which 66,7% received reversal treatment. In all, 67,0% of ischemic stroke cases and 57,7% of intracerebral hemorrhages were admitted to a Neurology department, with a median admission time of 7,82 hours. Additionally, 19,6% of ischemic stroke cases were referred to a TIA/stroke outpatient clinic.

Conclusion: The hospital met benchmarks in thrombectomy rates and nearly in door-to-needle time in thrombolysis. There is room for improvement in other areas. The results can be used to support further enhancement of acute stroke treatment in Iceland and as a basis for policy development.