Aims: This study aimed to describe New Zealand stroke reperfusion treatment trends between 2020 and 2024 and compares outcomes between patients first presenting to thrombectomy and non-thrombectomy centres to explore geographic inequities.
Methods: This observational registry-study used National Stroke Register data for patients receiving reperfusion therapy. Process outcomes included treatment rates and time delays and patient outcomes mortality and complications. We used logistic regression to control for potential confounders.
Results: In 2020, 1021/ 7333 (13.9%) ischaemic stroke patients received reperfusion therapy, increasing to 1237/ 6867 (18.0%) in 2024 (p <0.001). Thrombolysis rates increased from 11.2% in 2020 to 12.4% in 2024 (p = 0.038), with decreased symptomatic intracranial haemorrhage rate (3.6% to 1.5%; p = 0.0076) and 7-day mortality (8.5% to 5.6%; p < 0.001). Thrombectomy rates increased from 5.3% in 2020 to 9.7% in 2024 (p < 0.001), with no change in patient outcomes. Between 2020 and 2024, median door-to-needle time increased from 60 to 74 minutes (p < 0.001). The greatest intervention rate increases were observed among non-SCR centre first presenters. Patients first presenting to non-thrombectomy centre were less likely to be treated with thrombolysis within 60 minutes compared with thrombectomy centre presenters (31.7% vs 48.4%; p < 0.001; adjusted odds ratio of 2.8 [2.0-4.0]), but experienced similar patient outcomes.
Conclusion: New Zealand stroke reperfusion rates are rising, especially among non-thrombectomy centres, and outcomes following thrombolysis are improving. Thrombolysis treatment delays are worsening suggesting more resources are needed to maintain workflow efficiencies as case complexity is rising.