INTERNATIONAL PRACTICES IN OPTIMIZING TIME METRICS FOR REPERFUSION THERAPY IN ACUTE ISCHEMIC STROKE

Introduction. Acute ischemic stroke (AIS) remains one of the leading causes of mortality and long-term disability worldwide. Reperfusion therapy, including thrombolysis and thrombectomy, is highly time-sensitive and significantly improves patient outcomes when administered promptly. However, international variations in treatment time metrics and accessibility pose challenges to optimizing outcomes globally. The aim of the review:This review aims to analyze key time metrics for reperfusion therapy, such as door-to-puncture (DTP) and door-to-groin puncture (DTGP), in high- and upper-middle-income countries. It seeks to identify factors influencing treatment efficiency and outcomes to provide actionable recommendations for healthcare systems, including Kazakhstan. Materials and methods:A systematic review was conducted using PubMed, Scopus, Web of Science, and Cochrane Library databases. Studies published between 2005 and 2021 were included, focusing on time metrics such as DTP, onset-to-needle (OTN), DTGP, onset-to-groin puncture (OTGP), and onset-to-door (OTD). A total of 27 studies were selected using PRISMA guidelines, and key findings were extracted for comparative analysis. Results:The analysis revealed significant international variability in time metrics. Countries like Switzerland and the USA/Canada demonstrated shorter DTP and DTGP times, correlating with higher percentages of favorable outcomes at 90 days. These metrics underscore the importance of efficient emergency services and hospital workflows. Additionally, disparities in access to advanced stroke care were identified, particularly in regions with fewer stroke centers and endovascular specialists. Conclusion: This review highlights the critical role of optimizing time metrics to improve patient outcomes in AIS. International best practices, such as dual-modality approaches combining thrombolysis and thrombectomy, can serve as models for improving stroke care efficiency. For Kazakhstan, the findings emphasize the need to reduce treatment delays by enhancing prehospital systems and developing regional stroke centers. Future efforts should focus on addressing global disparities and standardizing key metrics to facilitate comparisons and improvements in care.