ESO East Supplement 2023 - 10

10
European Stroke Journal 8(1S)
Table 2. Baseline characteristics, management, and clinical
outcomes at discharge of the study population (n = 3590).
Variable
At baseline
Age, years, median (IQR)
Male sex, n (%)
Index stroke
AIS, n (%)
ICH, n (%)
TIA, n (%)
SAH, n (%)
CVT, n (%)
Undetermined, n (%)
In-hospital stroke, n (%)
Prior history of stroke, n (%)
NIHSS, median (IQR)
Acute management
Imaging within 1 h, n (%)
Reperfusion procedures, n (% AIS)
Intravenous thrombolysis alone, n (% AIS)
64 (55-74)
2193 (61.1)
2668 (74.3)
425 (11.8)
438 (12.2)
35 (1)
19 (0.5)
5 (0.1)
115 (3.2)
431 (12.9)
4 (2-10)
3129 (89.6)
525 (19.7)
420 (15.8)
Mechanical thrombectomy alone, n (% AIS) 65 (2.4)
Bridging therapy, n (% AIS)
40 (1.5)
Door to needle time, minutes, median (IQR) 40 (7-58)
Door to Groin time, minutes, median (IQR) 64 (16-116)
During hospitalization
Stroke unit/ICU hospitalization, n (%)
Dysphagia screening, n (%)
Mechanical ventilation, n (%)
Rehabilitation assessment, n (%)
AF screening, n (% AIS or TIA)
Known AF, n (% AIS or TIA)
Detected AF during hospitalization, n
(% AIS or TIA)
Carotid arteries imaging, n (% AIS or TIA)
Duration of hospitalization, days, median
(IQR)
At discharge
Antithrombotic treatment, n (% AIS or TIA) 2974 (95.8)
Anticoagulant treatment, n (% AF-related
AIS or TIA)
441 (73)
Statin treatment, n (% AIS or TIA)
Antihypertensive treatment, n (%)
Smoking cessation, n (%)
Discharge to home, n (%)
Cerebrovascular appointment, n (%)
Clinical outcomes at discharge
mRS score, median (IQR)
Excellent clinical outcome, n (%)
Good clinical outcome, n (%)
Death, n (%)
2461 (79.2)
2398 (66.8)
1043 (81.1)
2800 (78)
1664
1 (0-3)
1569 (60.1)
1862 (71.3)
82 (3.1)
IQR: interquartile range; AIS: acute ischemic stroke; ICH: intracerebral
hemorrhage; TIA: transient ischemic attack; SAH: subarachnoid hemorrhage;
CVT: cerebral venous thrombosis; NIHSS: National Institutes of
Health Stroke Scale; ICU: intensive care unit; AF: atrial fibrillation; mRS:
modified Rankin Scale.
1126 (31.4)
1851 (79.1)
129 (3.8)
2068 (57.6)
2637 (84.9)
378 (12.2)
225 (7.2)
2590 (83.4)
5 (3-10)
Overall
Discussion
The total number of patient registrations in RES-Q registry
remained stable throughout the years 2017-2021 in Greece,
with more than 3500 included patients in total. However,
not all sites maintained the registry utilization throughout
this 5-year period, with a median of 9 out of 20 sites (IQR
2) being active each year. Excessive workload of the medical
personnel, who is most commonly involved in patient
registries completion, may have accounted for the temporal
dropouts of the sites in data collection for the registry of
several sites. COVID-19 pandemic may have additionally
contributed to discontinuation of ongoing clinical research,
including continuing registrations in databases.31,32 On the
other hand, harmonization to one nationwide registry may
offer additional advantages, such as acknowledging potential
gaps regarding stroke care quality in one site compared
to others, providing clinical data and information that are
derived from a larger proportion of the Greek population,
directing efforts toward future stroke action plans based on
nationally representative data with the aim to become applicable
in different sites and areas of Greece.33,34
The geographical features of Greece, consisting of
numerous islands covering the 16.7% of the total country
area and a rather mountainous mainland, should also be
considered.35 Such a particular terrain complicates prompt
patient accessibility to primary or comprehensive stroke
centers and this may have significant implications for efficient
stroke management,36 especially when considering
that older population predominantly lives in rural areas.37
Measuring accessibility and addressing potential disparities
in stroke care between urban and rural territories is a highly
important step for designing a successful stroke management
infrastructure.38 However, representation of different
prefectures of Greece in the registry is poor, as shown in
Figure 1, with more than half of participating centers being
located within the prefecture of Attica, which covers
approximately 40% of Greek population. Therefore, no
firm evidence exists regarding stroke care quality in the
rural areas, highlighting the need for increased awareness
in the smaller, peripheral, stroke-ready centers to utilize a
nationwide registry and to become an active part of the
stroke action plan.39 Nowadays, involvement of strokeready
hospitals in stroke management might be further supported
by the use of telemedicine,40 which appears to be a
promising tool in Greece,41 and has been increasingly utilized
since the COVID-19 pandemic.42
Acute reperfusion treatment was offered in almost 20%
of AIS cases, which is comparable with other European
cohorts during similar time periods.43 As evident by time
metrics (DTN and DTG times), acute reperfusion treatment
was administered quite promptly, suggesting an accelerated
triage and effective acute management once the patient has
arrived at the hospital. Specifically for IVT, DTN time in
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