000			03796nam a22003737a 4500
003			OSt
005			20240305193738.0
008			221126b |||||||| |||| 00| 0 eng d
028			_b Phone: +255 28 298 3384
028			_b Fax: +255 28 298 3386
028			_b Email: vc@bugando.ac.tz
028			_b Website: www.bugando.ac.tz
040			_bEnglish _cDLC
041			_aEnglish
100			_aSarah Shali Matuja _946032
222			_aischemic stroke, large vessel occlusion, thrombectomy, morbidity and mortality, Tanzania
245			_aIschemic Stroke at a Tertiary Academic Hospital in Tanzania: A Prospective Cohort Study With a Focus on Presumed Large Vessel Occlusion
260			_aMwanza, Tanzania: _b Frontiers Media SA & _b Catholic University of Health and Allied Sciences [CUHAS – Bugando] _c2022
490			_vFrontiers in Neurology Volume 13
520			_aAbstract: Background: Large 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. Aims: We aimed to investigate the burden and outcomes of presumed LVO among patients with ischemic stroke admitted to a large tertiary academic hospital in Tanzania. Methods: This 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. Results: We 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. Conclusion: There 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.
700			_aFaheem Sheriff _946058
700			_a Mohamed Manji _946059
700			_aMohammad Rauf Chaudhury _946060
700			_a Alberto Maud _946061
700			_aVikas Gupta _946062
700			_a Gustavo J Rodriguez _938867
700			_aFrederick Lyimo _946063
700			_a Kezia Tessua _946064
700			_a Khuzeima Khanbhai _946034
700			_a Patricia Munseri _946033
700			_aRashid Ali Ahmed _946065
856			_uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC9330741/
942			_2ddc _cVM
999			_c19736 _d19736