Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion
BackgroundLarge vessel ischemic strokes account for more than one-third of all strokes associated with substantial morbidity and mortality without early intervention. The incidence of large vessel occlusion (LVO) is not known in sub-Saharan Africa (SSA). Definitive vessel imaging is not routinely av...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2022.882928/full |
| _version_ | 1811224806299795456 |
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| author | Sarah Shali Matuja Rashid Ali Ahmed Patricia Munseri Khuzeima Khanbhai Kezia Tessua Frederick Lyimo Gustavo J. Rodriguez Vikas Gupta Alberto Maud Mohammad Rauf Chaudhury Mohamed Manji Faheem Sheriff |
| author_facet | Sarah Shali Matuja Rashid Ali Ahmed Patricia Munseri Khuzeima Khanbhai Kezia Tessua Frederick Lyimo Gustavo J. Rodriguez Vikas Gupta Alberto Maud Mohammad Rauf Chaudhury Mohamed Manji Faheem Sheriff |
| author_sort | Sarah Shali Matuja |
| collection | DOAJ |
| description | BackgroundLarge vessel ischemic strokes account for more than one-third of all strokes associated with substantial morbidity and mortality without early intervention. The incidence of large vessel occlusion (LVO) is not known in sub-Saharan Africa (SSA). Definitive vessel imaging is not routinely available in resource-limited settings.AimsWe aimed to investigate the burden and outcomes of presumed LVO among patients with ischemic stroke admitted to a large tertiary academic hospital in Tanzania.MethodsThis cohort study recruited all consenting first-ever ischemic stroke participants admitted at a tertiary hospital in Tanzania. Demographic data were recorded, and participants were followed up to 1 year using the modified Rankin Scale (mRS). A diagnosis of presumed LVO was made by a diagnostic neuroradiologist and interventional neurologist based on contiguous ischemic changes in a pattern consistent with proximal LVO on a non-contrast computed tomography head. We examined factors associated with presumed LVO using logistic regression analysis. Inter-observer Kappa was calculated.ResultsWe enrolled 158 first-ever ischemic strokes over 8 months with a mean age of 59.7 years. Presumed LVO accounted for 39.2% [95% confidence interval (CI) 31.6–47.3%] and an overall meantime from the onset of stroke symptoms to hospital arrival was 1.74 days. Participants with presumed LVO were more likely to involve the middle cerebral artery (MCA) territory (70.9%), p < 0.0001. Independent factors on multivariate analysis associated with presumed LVO were hypertension [adjusted odds ratio (aOR) 5.74 (95% CI: 1.74–18.9)] and increased waist-hip ratio [aOR 7.20 (95% CI: 1.83–28.2)]. One-year mortality in presumed LVO was 80% when compared with 73.1% in participants without presumed LVO. The Cohen's Kappa inter-observer reliability between the diagnostic neuroradiologist and interventional neurologist was 0.847.ConclusionThere is a high burden of presumed LVO associated with high rates of 1-year morbidity and mortality at a tertiary academic hospital in Tanzania. Efforts are needed to confirm these findings with definitive vessel imaging, promoting cost-effective preventive strategies to reduce the burden of non-communicable diseases (NCDs), and a call for adopting endovascular therapies to reduce morbidity and mortality. |
| first_indexed | 2024-04-12T08:55:16Z |
| format | Article |
| id | doaj.art-b474825b887349d3a2241826f258d6ea |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-04-12T08:55:16Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-b474825b887349d3a2241826f258d6ea2022-12-22T03:39:25ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-07-011310.3389/fneur.2022.882928882928Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel OcclusionSarah Shali Matuja0Rashid Ali Ahmed1Patricia Munseri2Khuzeima Khanbhai3Kezia Tessua4Frederick Lyimo5Gustavo J. Rodriguez6Vikas Gupta7Alberto Maud8Mohammad Rauf Chaudhury9Mohamed Manji10Faheem Sheriff11Department of Internal Medicine, Catholic University of Health and Allied Sciences, Mwanza, TanzaniaDepartment of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United StatesDepartment of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, TanzaniaDepartment of Internal Medicine, Ocean Road Cancer Institute, Dar es Salaam, TanzaniaDepartment of Radiology, Muhimbili National Hospital, Dar es Salaam, TanzaniaDepartment of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United StatesDepartment of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United StatesDepartment of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United StatesDepartment of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United StatesDepartment of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Neurology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine El Paso, El Paso, TX, United StatesBackgroundLarge vessel ischemic strokes account for more than one-third of all strokes associated with substantial morbidity and mortality without early intervention. The incidence of large vessel occlusion (LVO) is not known in sub-Saharan Africa (SSA). Definitive vessel imaging is not routinely available in resource-limited settings.AimsWe aimed to investigate the burden and outcomes of presumed LVO among patients with ischemic stroke admitted to a large tertiary academic hospital in Tanzania.MethodsThis cohort study recruited all consenting first-ever ischemic stroke participants admitted at a tertiary hospital in Tanzania. Demographic data were recorded, and participants were followed up to 1 year using the modified Rankin Scale (mRS). A diagnosis of presumed LVO was made by a diagnostic neuroradiologist and interventional neurologist based on contiguous ischemic changes in a pattern consistent with proximal LVO on a non-contrast computed tomography head. We examined factors associated with presumed LVO using logistic regression analysis. Inter-observer Kappa was calculated.ResultsWe enrolled 158 first-ever ischemic strokes over 8 months with a mean age of 59.7 years. Presumed LVO accounted for 39.2% [95% confidence interval (CI) 31.6–47.3%] and an overall meantime from the onset of stroke symptoms to hospital arrival was 1.74 days. Participants with presumed LVO were more likely to involve the middle cerebral artery (MCA) territory (70.9%), p < 0.0001. Independent factors on multivariate analysis associated with presumed LVO were hypertension [adjusted odds ratio (aOR) 5.74 (95% CI: 1.74–18.9)] and increased waist-hip ratio [aOR 7.20 (95% CI: 1.83–28.2)]. One-year mortality in presumed LVO was 80% when compared with 73.1% in participants without presumed LVO. The Cohen's Kappa inter-observer reliability between the diagnostic neuroradiologist and interventional neurologist was 0.847.ConclusionThere is a high burden of presumed LVO associated with high rates of 1-year morbidity and mortality at a tertiary academic hospital in Tanzania. Efforts are needed to confirm these findings with definitive vessel imaging, promoting cost-effective preventive strategies to reduce the burden of non-communicable diseases (NCDs), and a call for adopting endovascular therapies to reduce morbidity and mortality.https://www.frontiersin.org/articles/10.3389/fneur.2022.882928/fullischemic strokelarge vessel occlusionthrombectomymorbidity and mortalityTanzania |
| spellingShingle | Sarah Shali Matuja Rashid Ali Ahmed Patricia Munseri Khuzeima Khanbhai Kezia Tessua Frederick Lyimo Gustavo J. Rodriguez Vikas Gupta Alberto Maud Mohammad Rauf Chaudhury Mohamed Manji Faheem Sheriff Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion Frontiers in Neurology ischemic stroke large vessel occlusion thrombectomy morbidity and mortality Tanzania |
| title | Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion |
| title_full | Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion |
| title_fullStr | Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion |
| title_full_unstemmed | Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion |
| title_short | Ischemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion |
| title_sort | ischemic stroke at a tertiary academic hospital in tanzania a prospective cohort study with a focus on presumed large vessel occlusion |
| topic | ischemic stroke large vessel occlusion thrombectomy morbidity and mortality Tanzania |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2022.882928/full |
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