Background: It is unknown if improvements in ischemic stroke (IS) outcomes reported
after cerebral reperfusion therapies (CRT) in developed countries are also applicable to the “real
world” scenario of low and middle-income countries. We aimed to measure the long-term outcomes
of severe IS treated or not with CRT in Brazil.
Methods: Patients from a stroke center of a state-run hospital were included. We compared the
survival probability and functional status at 3 and 12 months in patients with severe IS treated or
not with CRT. From 2010 to 2011, we performed intravenous reperfusion when patients arrived
within 4.5 h time-window (IVT group) and after 2011, mechanical thrombectomy (MT) combined
or not with intravenous alteplase (IAT group). Those who arrived >4.5 h in 2010-2011 and >6 h in
2012-2017 did not undergo CRT (NCRT group).
Results: From 2010 to 2017, we registered 917 patients: 74% (677/917) in the NCRT group, 19%
(178/917) in the IVT group and 7% (62/917) in the IAT group. Compared to the NCRT group,
IVT patients had a 28% higher (HR: 0.72; 95% CI 0.53-0.96) 3-month adjusted probability of survival
and risk of functional dependence was 19% lower (adjusted RR: 0.81; 95% CI 0.73-0.91).
For those who underwent MT, the adjusted probability of survival was 59 % higher (HR: 0.41;
95% CI 0.21-0.77) and the risk of functional dependence was 21% lower (adjusted RR: 0.79; 95%
CI 0.66-094). These outcomes remained significantly better throughout the first year.
Conclusion: CRT led to better outcomes in patients with severe IS in Brazil.