Background and purpose: In China, stroke center certification was launched in 2015, but little is known about its impact on intravenous thrombolysis. This study aimed to evaluate the effects of stroke center certification on the use of intravenous thrombolysis during a five-year period in South China. Methods: We retrospectively collected data regarding the use of recombinant tissue plasminogen activator (rt-PA) in 21 cities of Guangdong from 2015 to 2020. The annual thrombolysis rate was defined as the number of patients who underwent intravenous rt-PA therapy divided by the number of those who had acute ischemic stroke (AIS) within the same year. The density of stroke centers was calculated as the number of stroke centers divided by the corresponding residents. Spearman’s correlation analysis was used to determine the correlations between the annual thrombolysis rates and the number/density of stroke centers. Paired t-test was used to compare differences in growth in annual thrombolysis rates before and after having stroke center. Results: From 2015 to 2020, the annual rt-PA thrombolysis rates of Guangdong increased from 1.4% to 7.2%, which was accompanied by an increase in the number of stroke centers from 0 to 82 and density of stroke centers from 0.00 to 0.71 per million population. The average annual rt-PA use in stroke centers were higher than that in non-stroke centers from 2016 to 2020 (all P < 0.05). There was a positive correlation of annual thrombolysis rates with the number of stroke centers (r = 1.00, P = 0.0028) and with the density of stroke centers in the 21 cities from 2018 to 2020 (all P < 0.05). The growth in annual thrombolysis rates significantly accelerated at the city-level after having stroke centers (1.55 %/y vs. 0.77 %/y, P < 0.001). Conclusions: Stroke center certification may partially drive the increased use of rt-PA thrombolysis. Stroke center certification should be continually promoted to facilitate access to intravenous thrombolysis for patients with AIS.

A 41-year-old woman complained of sudden numbness of the left face and limbs without neck pain, paraparesis, urinary retention, or constipation. Neurologic examination revealed onionskin pattern hemifacial dysesthesia and disturbance of touch and proprioception sensation of the left limbs. T2WI and Diffusion weighted imaging (DWI) showed left posterior spinal cord infarction at the C1 level (Figure, A-D). Magnetic resonance angiography (MRA) demonstrated stenosis of bilateral vertebral arteries (Figure, E-F). High-resolution MRI revealed the high signals of intramural hematoma in bilateral vertebral arteries indicating the diagnosis of dissection (Figure, G-J). Isolated posterior spinal cord infarction is rare, and vertebral artery dissection should be considered as an etiologic mechanism. 1 Study Funding No targeted funding reported.Figure Angiographic and High-Resolution MRI of Bilateral Vertebral Artery Dissection T2WI (A) and DWI (B-D) show the left posterior spinal cord infarction (arrow). MRA (E-F) shows stenosis of vertebral arteries in the right V3 segment (arrows) and the left V3-V4 segments (arrowheads). High-resolution MRI of vertebral arteries (G-J) revealed the intramural hematoma indicating arterial dissection (right, arrow; left, arrowhead).