Clinical Presentation, Demographic Profile, Outcome, and Treatment Gap of Large Vessel Stroke – A Study from a Tertiary Care Hospital in Eastern India
Rajdeep Saha, Uma Sinharoy, Biman Kanti RayAbstract
Objectives:
Large vessel occlusion (LVO) stroke is typically more severe and associated with less favorable outcomes. But LVOs also provide an opportunity for neurovascular intervention in the form of endovascular therapy (EVT) within golden hours. This study is aimed to identify the time gap as well as treatment gap in LVO stroke at the primary care level, along with its risk factors and clinical features.
Methodology:
This prospective observational study included data from 104 patients with LVO stroke on Day 0, 7, or at the time of discharge and at 3 months over a period of 18 months. Glasgow Coma Scale, National Institute of Health Stroke scale (NIHSS), Modified Rankin Scale (MRS) and Barthel index were used for patient monitoring. SPSS version 27 was used for data analysis.
Results:
Majority of the cohort belonged to be middle-aged with a male preponderance. Hypertension (69.23%), diabetes (43.27%), addiction (54.82%), and anterior circulation LVO (81.7%) with aphasia (18.27%) were prevalent. About 55.8% of LVO patients attended primary care level after 4.5 h of their symptoms (mean time of 6.86 h). 64.4% of the study population was diagnosed as LVO more than 24 h later. NIHSS score at Day 0, with positive correlation with computed tomography collateral score and outcome (MRS score at day 7 and 90), was a significant observation.
Conclusion:
NIHSS score (Day 0), MRS during discharge, duration, and complications of hospital stay significantly affected long-term outcome. Significant correlation was found between socioeconomic status and education of the patients with time to identification of LVO.