Improvement of Functional Outcomes in Patients with Stroke who Received Alteplase for Over 15 Years: Japan Stroke Data Bank

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  • Ishigami Akiko
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center Department of Neurology, Keio University School of Medicine
  • Toyoda Kazunori
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center Department of Neurology, Keio University School of Medicine
  • Nakai Michikazu
    Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
  • Yoshimura Sohei
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Wada Shinichi
    Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
  • Sasahara Yusuke
    Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
  • Sonoda Kazutaka
    Department of Neurology, Saiseikai Fukuoka General Hospital
  • Miwa Kaori
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Koge Junpei
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Shiozawa Masayuki
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
  • Iwanaga Yoshitaka
    Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
  • Miyamoto Yoshihiro
    Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center
  • Nakahara Jin
    Department of Neurology, Keio University School of Medicine
  • Suzuki Norihiro
    Department of Neurology, Keio University School of Medicine
  • Kobayashi Shotai
    Shimane University School of Medicine
  • Minematsu Kazuo
    Medical Corporation ISEIKAI
  • Koga Masatoshi
    Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center

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<p> Aim: The nationwide verification of intravenous thrombolysis (IVT) was rarely performed after the extension of the therapeutic time window of alteplase or after the expansion of mechanical thrombectomy (MT). We aimed to examine the long-term change in accurate real-world outcomes of IVT in patients with acute ischemic stroke (AIS) using the Japan Stroke Databank, a representative Japan-wide stroke database.</p><p>Methods: We extracted all patients with AIS who received IVT with alteplase between October 11, 2005, the approval date for alteplase use for AIS in Japan, and December 31, 2020. Patients were categorized into three groups using two critical dates in Japan as cutoffs: the official extension date of the therapeutic time window for IVT to within 4.5 h of symptom onset and the publication date of the revised guideline, where the evidence level of MT was heightened. We assessed the yearly trend of IVT implementation rates and the secular changes and three-group changes in clinical outcomes at discharge.</p><p>Results: Of 124,382 patients with AIS, 9,569 (7.7%) received IVT (females, 41%; median age, 75 years). The IVT implementation rate has generally increased over time and plateaued in recent years. The proportion of favorable outcomes (modified Rankin Scale score of 0–2) increased yearly over 15 years. The results of the changes in the outcomes of the three groups were similar to those of the annual changes.</p><p>Conclusions: We revealed that IVT implementation rates in patients with AIS increased, and the functional outcome in these patients improved over 15 years. Therefore, the Japanese IVT dissemination strategy is considered appropriate and effective.</p>

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