Stroke reperfusion in Aotearoa New Zealand: 5-year trends and a comparison of stroke clot retrieval and non-stroke clot retrieval centre presenters

Background Intravenous thrombolysis (IVT) and stroke clot retrieval (SCR) are effective stroke reperfusion treatments with historical underuse and reported access disparities. Aims This study describes trends in stroke reperfusion treatment between 2020 and 2024 in New Zealand and compares outcomes between patients first presenting to SCR and non-SCR centres. Methods This observational registry-study uses data from the National Stroke Register for patients receiving reperfusion therapy. Outcomes include treatment rates, time delays, mortality and complications. Results In 2020, 1021 of 7333 (13.9%) patients who had an ischaemic stroke had reperfusion therapy, increasing to 1237 of 6867 (18.0%) in 2024 (p<0.001). The greatest increases in therapy rates were among non-SCR centre first presenters. IVT rates increased from 11.2% in 2020 to 12.4% in 2024 (p=0.038), with reduced rates of symptomatic intracranial haemorrhage (3.2% to 1.5%; p=0.0272) and day-7 mortality (8.5% to 5.6%; p<0.001). SCR 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, national median door-to-needle time increased from 60 to 74 min (p<0.001). Patients first presenting to SCR centres were more likely to be treated with IVT within 60 min (48.4% vs 31.7%; p<0.001; adjusted OR of 2.8 (95% CI 2.0 to 4.0)). Conclusion New Zealand stroke reperfusion therapy rates are rising, especially at non-SCR centres, and outcomes following IVT are improving. IVT treatment delays are worsening suggesting more resources are needed to maintain workflow efficiencies as case complexity is rising.