Prehospital delay and thrombolysis rates in posterior circulation stroke: a multicenter Latin American study
7 affiliations
- 1Universidad Andina del Cusco
- 2Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez
- 3Hospital Base de Valdivia
- 4Hospital Nacional Adolfo Guevara Velasco
- 5Instituto Neurológico, Hospital Internacional De Colombia
- 6Hospital Nacional Guillermo Almenara Irigoyen
- 7Hospital Nacional Carlos Seguín
Abstract
Objective: We aimed to evaluate the delay to emergency arrival in adults with acute Posterior circulation ischemic strokes (PCS) and the likelihood of receiving intravenous thrombolysis compared to anterior circulation ischemic strokes (ACS) across six different hospitals in Latin America.
Methods: This multicenter study in Latin America hospitals including three hospitals in Peru (Cusco, Arequipa, and Lima City), one in Colombia (Bogotá), one in Chile (Valdivia), and one in Mexico City. We analyzed adult patients treated between 2018 and 2023 with a confirmed diagnosis of ischemic stroke (IS). We evaluated demographic characteristics, initial NIHSS score, onset-to-door time (ODT), rate of intravenous thrombolysis (IVT), and other stroke-related characteristics. Medians with interquartile ranges (IQR) were calculated. IVT (yes/no) was evaluated using Firth penalized logistic regression including stroke circulation, age, sex, admission NIHSS, ODT, previous stroke, and previous evaluation at another hospital as covariates. Continuous predictors were modeled per year, NIHSS point, and ODT hour, respectively. Adjusted odds ratios (aOR) with 95% CI were reported, with p < 0.05 considered statistically significant.
Results: A total of 1,460 patients were included, 501 (34.3%) of whom had PCS, with a median age of 70 years (IQR 59–80). We found significant differences in median ODT between PCS and ACS (13 h, IQR 5–46 vs. 8.5 h, IQR 4–20; p < 0.001) and in IVT rates. In the adjusted analysis, each additional hour of ODT was associated with lower odds of IVT (aOR 0.88, 95% CI 0.85–0.92), whereas stroke circulation was not independently associated with IVT (PCS vs. ACS: aOR 0.66, 95% CI 0.39–1.11). Higher admission NIHSS was associated with higher odds of IVT (aOR 1.06 per point, 95% CI 1.03–1.09).
Conclusion: Patients with posterior circulation stroke had longer prehospital delays and lower observed rates of intravenous thrombolysis than those with anterior circulation stroke. However, stroke circulation was not independently associated with IVT after adjustment for ODT and other clinically relevant covariates. These findings highlight early recognition and reduction of prehospital delay as potential targets for improving access to reperfusion therapy in Latin America.
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BibTeX
@article{huamani2026prehospital,
title = {{Prehospital delay and thrombolysis rates in posterior circulation stroke: a multicenter Latin American study}},
author = {Charles Huamani and Andrés A. Mercado-Pompa and Alfonso León-Mantero and Víctor Oré-Montalvo and Iván Baracaldo-Santamaría and Hebert Puente-Vila and Melissa Pérez and Rocío B. Pacheco-Elgueta and Max Molina-Jara and Andrés Diaz-Guzman and Hesed Virto-Farfán and Vanessa Cano-Nigenda and Antonio Arauz},
journal = {Frontiers in Neurology},
year = {2026},
month = oct,
doi = {10.3389/fneur.2026.1941221},
url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1941221/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prehospital delay and thrombolysis rates in posterior circulation stroke: a multicenter Latin American study
AU - Charles Huamani
AU - Andrés A. Mercado-Pompa
AU - Alfonso León-Mantero
AU - Víctor Oré-Montalvo
AU - Iván Baracaldo-Santamaría
AU - Hebert Puente-Vila
AU - Melissa Pérez
AU - Rocío B. Pacheco-Elgueta
AU - Max Molina-Jara
AU - Andrés Diaz-Guzman
AU - Hesed Virto-Farfán
AU - Vanessa Cano-Nigenda
AU - Antonio Arauz
PY - 2026
DA - 2026/10/15
JO - Frontiers in Neurology
DO - 10.3389/fneur.2026.1941221
UR - https://www.frontiersin.org/articles/10.3389/fneur.2026.1941221/full
AB - Objective: We aimed to evaluate the delay to emergency arrival in adults with acute Posterior circulation ischemic strokes (PCS) and the likelihood of receiving intravenous thrombolysis compared to anterior circulation ischemic strokes (ACS) across six different hospitals in Latin America. Methods: This multicenter study in Latin America hospitals including three hospitals in Peru (Cusco, Arequipa, and Lima City), one in Colombia (Bogotá), one in Chile (Valdivia), and one in Mexico City. We analyzed adult patients treated between 2018 and 2023 with a confirmed diagnosis of ischemic stroke (IS). We evaluated demographic characteristics, initial NIHSS score, onset-to-door time (ODT), rate of intravenous thrombolysis (IVT), and other stroke-related characteristics. Medians with interquartile ranges (IQR) were calculated. IVT (yes/no) was evaluated using Firth penalized logistic regression including stroke circulation, age, sex, admission NIHSS, ODT, previous stroke, and previous evaluation at another hospital as covariates. Continuous predictors were modeled per year, NIHSS point, and ODT hour, respectively. Adjusted odds ratios (aOR) with 95% CI were reported, with p < 0.05 considered statistically significant. Results: A total of 1,460 patients were included, 501 (34.3%) of whom had PCS, with a median age of 70 years (IQR 59–80). We found significant differences in median ODT between PCS and ACS (13 h, IQR 5–46 vs. 8.5 h, IQR 4–20; p < 0.001) and in IVT rates. In the adjusted analysis, each additional hour of ODT was associated with lower odds of IVT (aOR 0.88, 95% CI 0.85–0.92), whereas stroke circulation was not independently associated with IVT (PCS vs. ACS: aOR 0.66, 95% CI 0.39–1.11). Higher admission NIHSS was associated with higher odds of IVT (aOR 1.06 per point, 95% CI 1.03–1.09). Conclusion: Patients with posterior circulation stroke had longer prehospital delays and lower observed rates of intravenous thrombolysis than those with anterior circulation stroke. However, stroke circulation was not independently associated with IVT after adjustment for ODT and other clinically relevant covariates. These findings highlight early recognition and reduction of prehospital delay as potential targets for improving access to reperfusion therapy in Latin America.
SN - 1664-2295
ER -