Acute Stroke Care in a Thrombolysis-Capable Emergency Department in Iraq: Patient Characteristics, Risk Factors, and Reperfusion Metrics From a One-Year Registry

Background Stroke remains an important cause of death and long-term disability. Contemporary data on acute stroke care in Iraq remain limited. Objective This study aimed to describe patient characteristics, vascular risk factors, stroke subtypes, and reperfusion metrics among patients presenting with acute stroke to a thrombolysis-capable tertiary center in Iraq. Methods This retrospective observational study analyzed prospectively maintained registry data from consecutive adult patients presenting with acute stroke to the emergency department of Al-Diwaniyah Teaching Hospital in Diwaniyah, Iraq, between October 2023 and September 2024. Demographic characteristics, stroke subtype, vascular risk factors, treatment patterns, and workflow metrics were evaluated. Results A total of 339 patients were included. The mean age was 64.1 ± 12.9 years, and 58.1% were male. Acute ischemic stroke accounted for 72% of cases, while intracerebral hemorrhage accounted for 28%. Hypertension was the most common vascular risk factor (70.5%), followed by diabetes mellitus (38.3%) and prior stroke/transient ischemic attack (22.7%). Multiple vascular risk factors were present in 57.5% of patients. Among patients with acute ischemic stroke, 50.8% arrived within 4.5 hours of symptom onset. Twenty-one patients received intravenous thrombolysis, representing 8.6% of all ischemic stroke cases and 16.9% of those arriving within 4.5 hours. The median door-to-needle time was 110 minutes (interquartile range (IQR): 90-140). Two patients underwent mechanical thrombectomy following transfer to another facility. Conclusions Patients presenting with acute stroke in this registry exhibited a high burden of modifiable vascular risk factors, and a substantial proportion presented at a relatively young age. Although half of ischemic stroke patients arrived within the therapeutic time window, reperfusion therapy utilization remained limited, and treatment delays were common. These findings identify important opportunities to strengthen stroke systems of care, improve workflow efficiency, and expand access to evidence-based acute stroke therapies in Iraq.