scholarly journals High Level of Serum Tissue Kallikrein Is Associated with Favorable Outcome in Acute Ischemic Stroke Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Fei Wu ◽  
Yifeng Ling ◽  
Lumeng Yang ◽  
Xin Cheng ◽  
Qiang Dong ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Area Under The Curve ◽  
Binary Logistic Regression ◽  
Reperfusion Therapy ◽  
Stroke Onset ◽  
Tissue Kallikrein ◽  
High Level

Background/Objectives. We sought to assess the association between a serum tissue kallikrein (TK) level and a 90-day outcome in acute ischemic stroke (AIS) patients who received acute reperfusion therapy. Methods. Consecutive AIS patients within 6 hours after stroke onset between December 2015 and August 2017 were prospectively recruited. Blood samples were collected before acute reperfusion therapy for serum TK measurement. Outcome was modified Rankin scale (mRS) score at 90 days after stroke onset. Binary logistic regression was performed to analyze the association between the baseline TK level and the clinical outcome. Results. Between December 2015 and August 2017, 75 patients (age range from 33 to 91 years, 72.0% male) were recruited in this study. Higher baseline TK was independently associated with a favorable functional outcome (mRS 0-2) (odds ratio 1.01, 95% confidence interval (CI) 1.00-1.02, p=0.047) and low mortality rate (odds ratio 0.98, 95% CI 0.96-1.00, p=0.049) at 90 days. Increased TK level was associated with 90 d mRS (0-2) with area under the curve of 0.719 (95% CI 0.596-0.842; p=0.002). Conclusions. Serum TK can be a promising predictor of clinical outcome in AIS patients who received acute reperfusion therapy.

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15 ◽  
Author(s):  
Sarah Yaziz ◽  
Ahmad Sobri Muda ◽  
Wan Asyraf Wan Zaidi ◽  
Nik Azuan Nik Ismail
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Treatment Decision ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods:  A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

scholarly journals Efficacy of Mechanical Thrombectomy using Penumbra ACETM Aspiration Catheter Compared to Stent Retriever SolitaireTM FR in Patients with Acute Ischemic Stroke

2021 ◽  
Vol 11 (4) ◽  
pp. 504
Author(s):  
Dalibor Sila ◽  
Markus Lenski ◽  
Maria Vojtková ◽  
Mustafa Elgharbawy ◽  
František Charvát ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Binary Logistic Regression ◽  
Stent Retriever ◽  
Good Clinical Outcome ◽  
Significant Difference ◽  
Aspiration Technique

Background: Mechanical thrombectomy is the standard therapy in patients with acute ischemic stroke (AIS). The primary aim of our study was to compare the procedural efficacy of the direct aspiration technique, using Penumbra ACETM aspiration catheter, and the stent retriever technique, with a SolitaireTM FR stent. Secondarily, we investigated treatment-dependent and treatment-independent factors that predict a good clinical outcome. Methods: We analyzed our series of mechanical thrombectomies using a SolitaireTM FR stent and a Penumbra ACETM catheter. The clinical and radiographic data of 76 patients were retrospectively reviewed. Using binary logistic regression, we looked for the predictors of a good clinical outcome. Results: In the Penumbra ACETM group we achieved significantly higher rates of complete vessel recanalization with lower device passage counts, shorter recanalization times, shorter procedure times and shorter fluoroscopy times (p < 0.001) compared to the SolitaireTM FR group. We observed no significant difference in good clinical outcomes (52.4% vs. 56.4%, p = 0.756). Predictors of a good clinical outcome were lower initial NIHSS scores, pial arterial collateralization on admission head CT angiography scan, shorter recanalization times and device passage counts. Conclusions: The aspiration technique using Penumbra ACETM catheter is comparable to the stent retriever technique with SolitaireTM FR regarding clinical outcomes.

scholarly journals Reperfusion Therapy Frequency and Outcomes in Mild Ischemic Stroke in the United States

Stroke ◽  
2020 ◽  
Vol 51 (11) ◽  
pp. 3241-3249 ◽  
Author(s):  
Hamidreza Saber ◽  
Kasra Khatibi ◽  
Viktor Szeder ◽  
Satoshi Tateshima ◽  
Geoffrey P. Colby ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Reperfusion Therapy ◽  
Interquartile Range ◽  
Nihss Score ◽  
Discharge Disposition ◽  
Younger Age

Background and Purpose: More than half of patients with acute ischemic stroke have minor neurological deficits; however, the frequency and outcomes of reperfusion therapy in regular practice has not been well-delineated. Methods: Analysis of US National Inpatient Sample of hospitalizations with acute ischemic stroke and mild deficits (National Institutes of Health Stroke Scale [NIHSS] score 0–5) from October 1, 2016, to December 31, 2017. Patient- and hospital-level characteristics associated with use and outcome of reperfusion therapies were analyzed. Primary outcomes included excellent discharge disposition (discharge to home without assistance); poor discharge disposition (discharge to facility or death); in-hospital mortality; and radiological intracranial hemorrhage. Results: Among 179 710 acute ischemic stroke admissions with recorded NIHSS during the 15-month study period, 103 765 (57.7%) had mild strokes (47.3% women; median age, 69 [interquartile range, 59–79] years; median NIHSS score of 2 [interquartile range, 1–4]). Considering reperfusion therapies among strokes with documented NIHSS, mild deficit hospitalizations accounted for 40.0% of IVT and 10.7% of mechanical thrombectomy procedures. Characteristics associated with IVT and with mechanical thrombectomy utilization were younger age, absence of diabetes, higher NIHSS score, larger/teaching hospital status, and Western US region. Excellent discharge outcome occurred in 48.2% of all mild strokes, and in multivariable analysis, was associated with younger age, male sex, White race, lower NIHSS score, absence of diabetes, heart failure, and kidney disease, and IVT use. IVT was associated with increased likelihood of excellent outcome (odds ratio, 1.90 [95% CI, 1.71–2.13], P <0.001) despite an increased risk of intracranial hemorrhage (odds ratio, 1.41 [95% CI, 1.09–1.83], P <0.001). Conclusions: In national US practice, more than one-half of acute ischemic stroke hospitalizations had mild deficits, accounting for 4 of every 10 IVT and 1 of every 10 mechanical thrombectomy treatments, and IVT use was associated with increased discharge to home despite increased intracranial hemorrhage.

scholarly journals Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Author(s):  
Xuting Zhang ◽  
Shenqiang Yan ◽  
Wansi Zhong ◽  
Yannan Yu ◽  
Min Lou
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Median Serum ◽  
The Relationship

Background and Purpose: We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT). Methods: This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria. Results: Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89–1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169–1.836]; P =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139–2.145]; P =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020–1.745]; P =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057–2.003]; P =0.022). Conclusions: An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.

scholarly journals Factors Associated with Procedural Thromboembolisms after Mechanical Thrombectomy for Acute Ischemic Stroke

Medicina ◽  
2020 ◽  
Vol 56 (7) ◽  
pp. 353
Author(s):  
Taek Min Nam ◽  
Ji Hwan Jang ◽  
Young Zoon Kim ◽  
Kyu Hong Kim ◽  
Seung Hwan Kim
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Mechanical Thrombectomy ◽  
Area Under The Curve ◽  
Multivariable Logistic Regression Analysis ◽  
Cutoff Value ◽  
Factors Associated ◽  
Procedural Time

Background and objective: Procedural thromboembolisms after mechanical thrombectomy (MT) for acute ischemic stroke has rarely been studied. We retrospectively evaluated factors associated with procedural thromboembolisms after MT using diffusion-weight imaging (DWI) within 2 days of MT. Materials and Methods: From January 2018 to March 2020, 78 patients with acute ischemic stroke who underwent MT were evaluated using DWI. Procedural thromboembolisms were defined as new cerebral infarctions in other territories from the occluded artery on DWI after MT. Results: Procedural thromboembolisms were observed on DWI in 16 patients (20.5%). Procedural thromboembolisms were associated with old age (73.8 ± 8.18 vs. 66.8 ± 11.2 years, p = 0.021), intravenous (IV) thrombolysis (12 out of 16 (75.0%) vs. 25 out of 62 (40.3%), p = 0.023), heparinization (4 out of 16 (25.0%) vs. 37 out of 62 (59.7%), p = 0.023), and longer procedural time (90.9 ± 35.6 vs. 64.4 ± 33.0 min, p = 0.006). Multivariable logistic regression analysis revealed that procedural thromboembolisms were independently associated with procedural time (adjusted odds ratio (OR); 1.020, 95% confidence interval (CI); 1.002–1.039, p = 0.030) and IV thrombolysis (adjusted OR; 4.697, 95% CI; 1.223–18.042, p = 0.024). The cutoff value of procedural time for predicting procedural thromboembolisms was ≥71 min (area under the curve; 0.711, 95% CI; 0.570–0.851, p = 0.010). Conclusions: Procedural thromboembolisms after MT for acute ischemic stroke are significantly associated with longer procedural time and IV thrombolysis. This study suggests that patients with IV thrombolysis and longer procedural time (≥71 min) are at a higher risk of procedural thromboembolisms after MT for acute ischemic stroke.

Collateral score on CT angiography in patients with acute ischemic stroke - A retrospective study.

2019 ◽  
pp. 1-7
Author(s):  
Mathan Raj ◽  
Shahizon Azura Mukari ◽  
Wan Asyraf Wan Zaidi ◽  
Ahmad Sobri Muda
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Area Under The Curve ◽  
Clinical Information ◽  
Poor Clinical Outcome ◽  
The Status ◽  
Potential Use ◽  
Prognostic Data

Objective: Clinically assessing the status of cerebral collaterals is thought to provide invaluable diagnostic and prognostic data in managing acute ischemic stroke (AIS) patients. In this study we present a report, based on commonly used collateral grading system, assessing the correlation between the collateral status seen on CT angiography and patients’ functional outcome at Day 90 in our institution. Method: Patients presenting to the Emergency Department within 6 hours of onset of stroke from January 2010 until December 2014 were chosen for the study. CT angiography source images were retrospectively reviewed and given a “collateral score” (CS) by a radiologist who was blinded to the patient’s clinical information on presentation, as well as the clinical outcomes at 90 days. Patients’ mRS score at 90 days was obtained retrospectively and compared against the “collateral score”. Results: 87 patients were enrolled into this study, of which 60 (69%) were male and 27 (31%) were female with a mean age of 60.3 years. In this study, 56 (64.4%) patients had a collateral score (CS) ? 2 and 31 (35.6%) patients had a CS < 2. Out of 56 patients who had a CS ? 2, 51 of them (91%) had good clinical outcome with a mRS ? 2. All the patients who had CS < 2 showed poor clinical outcome with a mRS > 2. The collateral score predicts accurately the clinical outcome with an area under the curve (ROC) of 0.75 (95% CI, 0.675-0.871, P=0.001). There is significant Spearman correlation between CS and the clinical outcome at Day 90, in patients with AIS during CTA analysis. Conclusion: Our data supports the potential use of CS analysis in predicting clinical outcome of patients with AIS. Nevertheless, further study on a larger scale is strongly suggested to verify the reliability and reproducibility of CS assessment in CTA analysis prior to reperfusion in AIS patients.

scholarly journals Blood Pressure and Early Clinical Outcome Among Acute Ischemic Stroke Patients

2011 ◽  
Vol 38 (2) ◽  
pp. 225-229 ◽  
Author(s):  
Jintao Zhang ◽  
Ying Peng ◽  
Huanqing Fan ◽  
Mei Chen ◽  
Tan Xu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Resonance Imaging ◽  
Stroke Patients ◽  
Short Term ◽  
Tomography Scan

ABSTRACT:Objectives:The association between blood pressure (BP) and short-term clinical outcome of acute ischemic stroke is inconclusive. We investigated the association between BP in the first 72 hours following admission and death in-hospital and neurologic deficiency at discharge among patients with acute ischemic stroke.Methods:A total of 2675 acute ischemic stroke patients confirmed by a computed tomography scan or magnetic resonance imaging were included in the present study. Blood pressure in the first 72 hours after admission and other study variables were collected for all ischemic stroke patients. Neurological functions National Institute of Health Stroke Scale (NIHSS) were evaluated by trained neurologists at discharge. The study outcome was defined as death in-hospital and neurologic deficiency (NIHSS≥10) at discharge.Results:Systolic and diastolic BP were significantly and positively associated with odds of study outcome in acute ischemic stroke. For example, compared to those with a systolic BP<140 mmHg, multiple-adjusted odds ratio (95% confidence interval) of study outcome was 3.29(1.22, 8.90) among participants with systolic BP of 180-219 mmHg,P<0.05; compared to those with a diastolic BP<90 mmHg, multiple-adjusted odds ratio of study outcome was 7.05(1.32, 37.57) among participants with diastolic BP ≥ 120 mmHg,P<0.05.Conclusion:Systolic BP≥180 and diastolic BP≥120 were significantly and positively associated with death in-hospital or neurologic deficiency at discharge among patients with acute ischemic stroke.

Collateral score on CT angiography in patients with acute ischemic stroke - A retrospective study

2019 ◽  
Vol 1 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Mathan Raj ◽  
Shahizon Azura Mukari ◽  
Wan Asyraf Wan Zaidi ◽  
Ahmad Sobri Muda
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Ct Angiography ◽  
Area Under The Curve ◽  
Clinical Information ◽  
Poor Clinical Outcome ◽  
The Status ◽  
Potential Use ◽  
Prognostic Data

Objective: Clinically assessing the status of cerebral collaterals is thought to provide invaluable diagnostic and prognostic data in managing acute ischemic stroke (AIS) patients. In this study we present a report, based on commonly used collateral grading system, assessing the correlation between the collateral status seen on CT angiography and patients’ functional outcome at Day 90 in our institution. Method: Patients presenting to the Emergency Department within 6 hours of onset of stroke from January 2010 until December 2014 were chosen for the study. CT angiography source images were retrospectively reviewed and given a “collateral score” (CS) by a radiologist who was blinded to the patient’s clinical information on presentation, as well as the clinical outcomes at 90 days. Patients’ mRS score at 90 days was obtained retrospectively and compared against the “collateral score”. Results: 87 patients were enrolled into this study, of which 60 (69%) were male and 27 (31%) were female with a mean age of 60.3 years. In this study, 56 (64.4%) patients had a collateral score (CS) ? 2 and 31 (35.6%) patients had a CS < 2. Out of 56 patients who had a CS ? 2, 51 of them (91%) had good clinical outcome with a mRS ? 2. All the patients who had CS < 2 showed poor clinical outcome with a mRS > 2. The collateral score predicts accurately the clinical outcome with an area under the curve (ROC) of 0.75 (95% CI, 0.675-0.871, P=0.001). There is significant Spearman correlation between CS and the clinical outcome at Day 90, in patients with AIS during CTA analysis. Conclusion: Our data supports the potential use of CS analysis in predicting clinical outcome of patients with AIS. Nevertheless, further study on a larger scale is strongly suggested to verify the reliability and reproducibility of CS assessment in CTA analysis prior to reperfusion in AIS patients.

Evaluation of the clot burden score (cbs) for acute ischemic stroke (ais) in intent-to-treat patients.

2019 ◽  
pp. 11-15
Author(s):  
Sarah Yaziz ◽  
Ahmad Sobri Muda ◽  
Wan Asyraf Wan Zaidi ◽  
Nik Azuan Nik Ismail
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Rank Correlation ◽  
Treatment Decision ◽  
Roc Curves ◽  
Significant Negative Correlation ◽  
Clot Burden

Background : The clot burden score (CBS) is a scoring system used in acute ischemic stroke (AIS) to predict patient outcome and guide treatment decision. However, CBS is not routinely practiced in many institutions. This study aimed to investigate the feasibility of CBS as a relevant predictor of good clinical outcome in AIS cases. Methods: A retrospective data collection and review of AIS patients in a teaching hospital was done from June 2010 until June 2015. Patients were selected following the inclusion and exclusion criteria. These patients were followed up after 90 days of discharge. The Modified Rankin scale (mRS) was used to assess their outcome (functional status). Linear regression Spearman Rank correlation was performed between the CBS and mRS. The quality performance of the correlations was evaluated using Receiver operating characteristic (ROC) curves. Results: A total of 89 patients with AIS were analysed, 67.4% (n=60) male and 32.6% (n=29) female. Twenty-nine (29) patients (33.7%) had a CBS ?6, 6 patients (6.7%) had CBS <6, while 53 patients (59.6%) were deemed clot free. Ninety (90) days post insult, clinical assessment showed that 57 (67.6%) patients were functionally independent, 27 (30.3%) patients functionally dependent, and 5 (5.6%) patients were deceased. Data analysis reported a significant negative correlation (r= -0.611, p<0.001). ROC curves analysis showed an area under the curve of 0.81 at the cut-off point of 6.5. This showed that a CBS of more than 6 predicted a good mRS clinical outcome in AIS patients; with sensitivity of 98.2%, specificity of 53.1%, positive predictive value (PPV) of 76%, and negative predictive value (NPV) of 21%. Conclusion: CBS is a useful additional variable for the management of AIS cases, and should be incorporated into the routine radiological reporting for acute ischemic stroke (AIS) cases.

scholarly journals Disentangling Sex Differences in Use of Reperfusion Therapy in Patients With Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (8) ◽  
pp. 2332-2338
Author(s):  
Jeppe Mainz ◽  
Grethe Andersen ◽  
Jan Brink Valentin ◽  
Martin Faurholdt Gude ◽  
Søren Paaske Johnsen
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Time Delay ◽  
Acute Ischemic Stroke ◽  
Emergency Medical Services ◽  
Symptom Onset ◽  
Odds Ratio ◽  
Stroke Unit ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy

Background and Purpose: Previous studies from local settings have reported that women with acute ischemic stroke have a lower chance of receiving reperfusion therapy treatment, including intravenous thrombolysis and thrombectomy, than men, but the underlying mechanisms of this disparity have not been identified. We aimed to examine sex differences in the utilization of reperfusion therapy focusing on all the phases of pre- and in-hospital time delay in a nationwide population-based cohort. Methods: This study was based on data from nationwide public registries. The study population included patients aged at least 18 years admitted with acute ischemic stroke using emergency medical services in Denmark dispatched after an emergency call in the period 2016 to 2017. Study outcomes included time delays from symptom onset to start of reperfusion therapy and use of reperfusion therapy. Data were analyzed using multivariable quantile regression and logistic regression. Results: A total of 5356 stroke events fulfilled the inclusion criteria. Women (26.6%) were less likely to receive intravenous thrombolysis than men (30.2 %), corresponding to an unadjusted odds ratio of 0.84 (95% CI, 0.74–0.95). In addition, women experienced a 20 minutes longer median time delay from stroke symptom onset to stroke unit arrival than men. Adjusting for onset-to-door time only appeared to have a limited effect on the sex differences in use of intravenous thrombolysis, whereas the odds ratio was 1.06 (95% CI, 0.93–1.21) when adjusting for age at stroke, stroke severity, and cohabitation status. No sex difference was observed for the use of thrombectomy. Conclusions: Women received less reperfusion therapy than men and had a longer time delay from symptom onset to stroke unit arrival, primarily due to a longer delay from symptom onset to emergency medical services call. These differences appeared to be due to the higher age and the higher proportion of women living alone at the time of the stroke.

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