ESO East Supplement 2023 - 12

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European Stroke Journal 8(1S)
Figure 3. Distribution of modified Rankin Scale scores at discharge (Grotta bars) in the two treatment groups. Acute reperfusion
therapies were independently associated with higher odds of reduced disability (one point reduction across all mRS scores) at
hospital discharge (common OR 1.93; 95% CI 1.45-2.58; p < 0.001).
therapies in milder strokes. However, IVT has been associated
with improved clinical outcomes both at discharge and
at 3-month follow-up among AIS patients with mild stroke
severity (NIHSS-score 0-5).50,51 Furthermore, several deficits,
that are perceived as mild or cannot be even captured
with the NIHSS, may have an important impact on everyday
functionality and lead to substantial disability of
patients.52 Therefore, clinicians should be more critical and
avoid a priory excluding AIS patients with milder strokes
from IVT. Data regarding endovascular treatment for mild
AIS due to large vessel occlusion are less conclusive, with
several cohorts providing conflicting results.53-55 An individualized
approach may be considered based on the degree
of disability, perfusion mismatch, and collateral circulation
status,56 at least until ongoing randomized controlled clinical
trials in this field provide more definitive results.57,58
When baseline characteristics, including stroke severity,
were balanced among patients treated and not treated with
acute reperfusion therapies using propensity score matching,
we documented an independent association between
IVT and/or EVT with improved clinical outcomes at discharge.
This finding confirms that delivery of acute reperfusion
therapies is safe and effective in real-world evidence
settings in a Southern European country like Greece. This
observation also highlights that further actions should be
undertaken to increase the availability of acute reperfusion
therapies across the whole Greek territory.
In Greece, hospitalization in dedicated stroke units with
close monitoring of patients was mostly reserved for those
receiving acute reperfusion treatments. However, the rates
of stroke unit admission increased in sites that continuously
utilized the RES-Q registry and had access to data for stroke
care quality evaluation. Stroke unit hospitalization has been
associated with better clinical outcomes for all stroke
patients7,59 and thus, direct admission and spending at least
90% of the hospitalization in a stroke unit is recommended.60
Acute interventions, thorough patient evaluation,
and secondary prevention institution may be more
accessible and offered by clinicians with specialist training
and expertise in stroke in the setting of a stroke unit.61,62
Ideally, all acute stroke patients, including TIA patients,
should be hospitalized in such settings.17,63 Establishment
of stroke units in strategic locations across Greece is an
important step for a comprehensive and successful stroke
management plan and should be considered during infrastructure
formation by policymakers.
Limitations
This is a retrospective study of prospectively collected data
in a voluntary, web-based registry, and inherent limitations
should be acknowledged. First, possibly selection bias in
registering patients cannot be excluded; for example, two
sites presented unusually high rates of reperfusion therapy
(Athens Medical Center and AHEPA Hospital presenting a
reperfusion rate of 58% and 47%, respectively), implying
that there may have been a preference of inclusion for
patients receiving acute reperfusion therapies. However,
the contribution of these sites in the overall study population
was small (0.9% and 1.1%, respectively) and confounding
of the results is considered unlikely. Moreover,
the need for signed informed consent may also have been a
ESO East Supplement 2023

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