Abstract
Background: Intravenous thrombolysis (IVT) and stroke clot retrieval (SCR) are effective stroke reperfusion treatments with historical underuse and reported access disparities.
Aims: This study describes trends in stroke reperfusion treatment between 2020 and 2024 in New Zealand and compares outcomes between patients first presenting to SCR and non-SCR centres.
Methods: This observational registry-study uses data from the National Stroke Register for patients receiving reperfusion therapy. Outcomes include treatment rates, time delays, mortality and complications.
Results: In 2020, 1021 of 7333 (13.9%) patients who had an ischaemic stroke had reperfusion therapy, increasing to 1237 of 6867 (18.0%) in 2024 (p<0.001). The greatest increases in therapy rates were among non-SCR centre first presenters. IVT rates increased from 11.2% in 2020 to 12.4% in 2024 (p=0.038), with reduced rates of symptomatic intracranial haemorrhage (3.2% to 1.5%; p=0.0272) and day-7 mortality (8.5% to 5.6%; p<0.001). SCR rates increased from 5.3% in 2020 to 9.7% in 2024 (p<0.001), with no change in patient outcomes. Between 2020 and 2024, national median door-to-needle time increased from 60 to 74 min (p<0.001). Patients first presenting to SCR centres were more likely to be treated with IVT within 60 min (48.4% vs 31.7%; p<0.001; adjusted OR of 2.8 (95% CI 2.0 to 4.0)).
Conclusion: New Zealand stroke reperfusion therapy rates are rising, especially at non-SCR centres, and outcomes following IVT are improving. IVT treatment delays are worsening suggesting more resources are needed to maintain workflow efficiencies as case complexity is rising.